A175 HOME PARENTERAL NUTRITION (HPN): INDICATIONS FOR THERAPY AND OUTCOMES FOR PATIENTS IN A SINGLE-CENTRE, CANADIAN HPN PROGRAM (1996–2018).
Bibliographic record
Abstract
Parenteral nutrition (PN) is a life-sustaining therapy for patients who are unable to maintain adequate oral or enteral nutritional intake; for patients who do not require additional, intensive medical therapy, home PN (HPN) offers a cost-effective option for long-term nutritional support. The indications for HPN vary markedly in different centres, in part due to concerns regarding the outcomes for patients who have an incurable underlying diagnosis. To evaluate the indications for HPN and patient outcomes in a single-centre, HPN program with respect to the patients’ underlying diagnosis. A registry of all patients referred to a single-centre for consideration of HPN over a 22-year period was analysed to determine the numbers of patients who started HPN, the indication for HPN, the duration of HPN therapy and patient survival. Descriptive statistical analyses were performed. From 1996 to 2018, 849 patients were referred for HPN; of these, 479 (56%) patients (292F, 187M) started HPN. The mean age at the start of HPN was 51.2 yrs (SD: 15.2); the median duration of HPN was 103 days (IQR: 43–246). The primary reasons for starting HPN were: intestinal obstruction (176: 34.6%), fistula (124: 24.4%), short bowel syndrome [SBS] (120: 23.6%), intestinal dysmotility (44: 8.7%), intestinal mucosal disease (19: 3.7%) and others (25: 4.9%). Patients receiving HPN for bowel obstruction or fistulizing disease (bowel rest) were, generally, older and the median duration of HPN therapy was significantly lower for these patients (Table). SBS patients had the longest duration of HPN; 44 of 120 (35.7%) SBS patients died on HPN or within 1 month of stopping (age at start: 55.7 (SD: 14.8) yrs; median HPN duration: 516 (IQR: 177–1063) days); of the 76 remaining SBS patients, 17 continue HPN (age at start: 51.7 (SD: 15.6) yrs; median HPN duration: 840 (IQR: 243–1821) days). Over 40% of patients considered for HPN can be managed, solely, by optimisation of their oral and enteral intake of food and nutrients. For those patients who started HPN, the median treatment duration was greater than 3 months. Short-term HPN (median 2–3 months) was sufficient to support patients requiring bowel rest (obstruction, fistulae) but patients with intestinal failure (SBS, dysmotility) required HPN for longer periods (median 7–14 months) and many SBS patients currently require permanent HPN to survive. Reason for HPN None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".