The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.
Chronic Disease ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Korea ; Organization and Administration ; Parenteral Nutrition, Home Total* ; Quality-Adjusted Life Years

Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting “nutritional failure” which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.
Bone Diseases ; Child ; Citrulline ; Enterocytes ; Humans ; Intestinal Diseases ; Intestinal Mucosa ; Intestinal Pseudo-Obstruction ; Liver Diseases ; Micronutrients ; Parenteral Nutrition ; Parenteral Nutrition, Home ; Prognosis ; Rehabilitation ; Short Bowel Syndrome

A 69-year-old man was consulted to our Home Health Care department for home parenteral enteral nutrition. He was diagnosed with Kennedy disease. He had swallowing difficulty and bowel ischemia. We provided nutritional support in a variety of ways in order to suit his condition. The role of the home care nurse involves training methods depending on changes in the nutritional support to patient and care giver. However, in the case of Kennedy disease, increasing the target patient's nutritional requirements as calculated was difficult.
Aged ; Bulbo-Spinal Atrophy, X-Linked* ; Caregivers ; Deglutition ; Delivery of Health Care ; Enteral Nutrition* ; Home Care Services ; Humans ; Ischemia ; Nutritional Requirements ; Nutritional Support ; Parenteral Nutrition

Intestinal transplant wait-list mortality is higher than for other organ transplants. This is a review to identify the main problems contributing to the high risk of intestinal transplant candidates and to provide recommendations on how to resolve them. Intestinal transplant, home parenteral nutrition, and intestinal rehabilitation articles issued from the main intestinal transplantation centers from 1987 to 2010 were reviewed. The risk factors for adult and child transplant wait-list mortality were parallel to those of parenteral nutrition. Therefore, primary care givers managing patients with intestinal failure should establish a cooperative link to facilities with active intestinal failure programs from the early period, when anticipation for the parenteral nutrition (PN) requirement is more than 50% in the 3 months of initiation. An intestinal failure care program should include or establish an active collaborative relationship with centers performing intestinal rehabilitation and transplantation. Intestinal rehabilitation centers are expected to establish a multiprofessional team composed of medical doctors, nurses, pharmacists, dieticians, surgeons, gastroenterologists, social workers, fund managers, PN-solution providers, and intestinal transplantation surgeons. National registries for patients undergoing intestinal failure should be established, and home-PN providers should participate.
Adult ; Aluminum Hydroxide ; Carbonates ; Child ; Financial Management ; Humans ; Intestines ; Organ Transplantation ; Parenteral Nutrition ; Parenteral Nutrition, Home ; Pharmacists ; Primary Health Care ; Registries ; Rehabilitation Centers ; Risk Factors ; Social Workers ; Transplants ; Waiting Lists