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Biomedical subjects

A Zarazaga Monzón

Publications and source records attributed to A Zarazaga Monzón.

7 recordsLinked to original sources
PubMed1999

[Perioperative nutrition].

The incidence of malnutrition in hospitalized patients is high in our environment, and sometimes it worsens during the hospital stay (67%). In surgical patients who will be subjected to a surgical intervention and whose ingestion will be suppressed for digestive repose after the post-operative period, the situation becomes more complicated as in addition to their malnutrition there is an increased energetic-proteineic need due to the aggression. The direct relationship between severe malnutrition and an immune deficiency is translated into an increased morbidity (78%), into some extreme cases of mortality (24%), and always into longer hospitalizations. Implementing an adequate nutrition early will favorably influence the surgical results like any other therapeutic support measure. On the other hand, with the increased knowledge of the physiopathology of the gastrointestinal tract and its immunological function (GALT), the theoretical beneficial effect of intestinal repose has changed signs, with it being recommended to implement enteral nutrition rapidly post-operatively, with the physiological and practical advantages of enteral nutrition as opposed to parenteral nutrition being accepted unanimously. Immunomodulatory diets have shown their beneficial effect in specific situations: critical patients, septicemics, poly-traumatized patients, digestive tumor disease, etc., with infectious, scarring, and hospitalization complications decreasing significantly. When indicating peri-operative nutrition we must assess the disease and the characteristics hereof (benign, malignant, acute, or chronic), the surgical procedure used (aggression), the patient's prior nutritional status, the energetic needs (degree of aggression), the expected post-operative period, the expected fasting period (in function of the recommended intestinal repose and the expected complications), the available artificial nutrition routes (by patient limitations or strategic limitations of our environment), and finally, whenever possible, to use the enteral pathway.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Women and children first?....].

The goal of the National Health System (SNS in its Spanish acronym) does not consist in distributing to everyone an identical dose of health services but in establishing a balance between those who are ill and those who are healthy in the course of their lives, and concentrating its interventions on those who are worse. In an advanced health care system, there are very few actions by health personnel that can be assessed as "lives saved": more often than not, these actions manage to delay the end and are occasionally limited to improving the quality of the years patients live, without extending their number. It is therefore clearly necessary to find appropriate units of measurement to assess the benefits and utility of all health-related procedures. When effecting a cost-effectiveness study and assessing the results obtained, it is necessary to differentiate between quality of life (personal), utility (personal) and the utility of the procedure or process when applied to our patients. This utility is determined by means of the additional quality and quantity of life, measured in a single unit, QALY, but this cost-effectiveness analysis would be constrained in patients with a shortened life expectancy and/or reduced quality of life due to old age or degenerative disease, thus skewing the distribution of resources in favour of younger population groups. In order to redress this situation, the use of corrective measurements such as EQALY is proposed. We believe that neither age nor illness in themselves limit the application of resources, providing that we can prove a useful result for the patient.

Adult↗
PubMedDate not supplied

[Structured lipids in nutritional support].

Currently there are many studies in international medical literature which show the effectiveness and safety of the different lipid emulsions existing on the market, both in clinical and experimental studies. When referring to lipid emulsions, we mean those based exclusively on LCT and those which provide physical combinations of LCT/MCT oils, and especially the new presentations of chemical combinations known as structured lipid emulsions. These structured lipids generated in a random structuring of LCT and MCT inside the same trialcylglycerol molecule should be considered not only from the standpoint of their nutrient effects, but also from the standpoint of their particular properties and future pharmacological possibilities. These exceed the nutrient effect itself as well as the tolerance, since they open up a field towards the intake of fatty acids, amino acids or drugs in one single molecule of triglyceride. Structured lipids also have great possibilities in the field of enteral nutrition, and it has been shown that the structuring of more conventional lipids with omega-3 series lipids has a great future in immuno-nutrition.

Animals↗
PubMedDate not supplied

[Evaluation of the quality of life in artificial nutrition].

If we define quality of life as being the social, physiological, mental intellectual, and general well being of people, we realize that there is no known health care system that is able to guarantee that well being in all its possible aspects. When we as clinicians assess the positive effects of a treatment applied to a patient, we are not only assessing the offered quality of life, but also the quantity of life, so what we are really assessing is the usefulness. We could say, therefore, that while the quality of life is subjective, not exact, and cannot be quantified, the usefulness on the other hand, can and should be measured and quantified, even though, as this is a subjective assessment, it is somewhat difficult to quantify. The object of our publication is to find an appropriate method for assessing this parameter in the area that concerns us: artificial nutrition. Artificial nutrition is indicated when the patient cannot does not want to, or does not know how to eat in the natural manner. Therefore, in principle it could seem inhuman and even unethical to deny a vital support measure that is practically without any risks in a patient who cannot feed him-or herself. However, in a situation of limited resources, if the treatment were inappropriate we should consider that possibility. Under these circumstances we could consider that even a concept as essential as nutrition (in this case artificial) would lose its inalienable character. In order to assess usefulness, one must include parameters that can be quantified in percentages and whose results can be set out in units of time (years, months, or days). We use the concept of the individual usefulness, whose unit of time is the QALY (Quality Adjusted Life Years). In 1996 we made a personal modification of Rosser's Index, which was specific for evaluating the quality of life obtained by means of artificial nutrition. This consisted of substituting the assessment parameters of intensity of pain, by other that are specific in function of the limitation of the ingestion capacity presented by the patient who was subjected to AN. The third factor that corresponds to the concept of usefulness would be the index of beneficial applicability percentage of patients who benefit from the support. The combination of these three factors, applicability, life expectancy, and quality of life, would yield the usefulness of the procedure. In order to assess usefulness in all its aspects, one must also define intention, as this can be applied with three goals: essential or curative, complementary or adjuvant, and maintenance or merely palliative. We can say that the economical limitations and the cost of the therapeutic resources leads to rationing by the administration. In the face of this action, we would recommend a rational and reasonable restriction of the available resources, which lead to the so-called rationalization, a term that is more correct ethically and esthetically, than rationing. As a final conclusion we could state that ethics and economics help us to use the resources appropriately, without any contradictions, as the economy attempts to give the society the greatest possible degree of well being based on the available resources, and that is an ethical objective, The quantification of the benefits obtained by applying a treatment using measureable units, involves socio-economic concepts such as usefulness, cost/benefit, quality of life, etc. should not elicit rejection as though we were dealing with a merchandising of our ethical values. We clinicians are capable of assessing this together, both with regard to the obtained costs and benefits, and with regard to the final results, both intra- and extra-hospital, and using the appropriate tools, we can reach conclusions that can guide us objectively in making decisions, with the aim of optimizing our therapeutic actions.

Costs and Cost Analysis↗