BAPEN Conference


Quality Parenteral Nutrition – An Ideal Mixed Bag


The Pennington Lecture 2010 was delivered by Rebecca White, Pharmacy Team Manager, Oxford Ratcliffe Hospital NHS Trust


“I felt incredibly honoured to be asked to deliver the Pennington,” said Rebecca, “not only because of all the experts who have delivered this keynote lecture before me but also because I worked with Professor Pennington previously. It was also a big


responsibility for me representing the pharmacists and the pharmacy profession.” Rebecca’s topic of quality in parenteral nutrition echoed many similar themes at Conference and matched interests of delegates as


well as BAPEN’s current agenda. She acknowledges however that this was a great opportunity to provide a focus on the actual therapy and the solutions, areas that do not perhaps get as much attention as they should. “Outside of pharmacy,” added Rebecca, “some topics such as the risk involved with these invasive therapies are not given enough time for consideration. I hope my lecture provided delegates with a better understanding of the risks of the therapy they use and they went away with some practical suggestions to take back to their own organisations on how to improve quality.”


• The Nutrition Society Cuthbertson Medal Lecture was delivered by Dr Barbara Fielding, University of Oxford on the topic of ‘Tracing the Fate of Dietary Fat: Metabolic studies in humans’


• The Inaugural Powell-Tuck Prize Presentation was delivered by G Moran from the University of Manchester for the original communication on ‘Gut Hormones and Appetite Deregulation in Crohn’s Disease’ (OC02)


Cutting Edge Sessions at Conference –


Research and practice Surgery took its rightful place at BAPEN Conference this year as innovation and growth in established and emerging procedures are presenting new challenges to the multi- disciplinary teams dealing with nutritional issues. Ruth McKee, Consultant Colorectal Surgeon


at Glasgow Royal Infirmary, who chaired the key symposium, said: “There were two ‘reality checks’ that came across clearly for me and I hope for all delegates. First, it is clear that for oncologists if nutrition could be dealt with by a drug then these specialists will be far more interested! It is important in daily practice that we think about our colleagues’ viewpoint and work hard to continue to make the case for nutritional care. Second, the surprising result from the National Audit of Oseophago-gastric Surgery that showed that patients who had a Jejunostomy did not seem to have any advantage over those who did not is a result we all need to consider carefully.


One of the clear highlights of the Bariatric Surgery – Effective long-term


treatment option Bariatric surgery and best practice management of patients was explored further in the Nestlé Nutrition Institute sponsored Satellite Symposium.


Bariatric surgery is increasingly cited as effective long-term treatment option for patients with higher BMIs and associated co- morbidities. This field of practice is relatively new in the UK and at present there is little consensus amongst specialist centres the issues surrounding the management of an undeniably complex and challenging patient group. The Nestle Institute symposium considered two aspects of the role of the dietitian within the bariatric MDT. Firstly Kelli Edmiston, Bariatric Dietitian, Chelsea and Westminster Hospital, spoke about the need for patients to achieve pre- surgical weight loss to optimise surgery and outcome. Primarily achieved through reduced abdominal fat and reduction in the volume and fat of the liver, other improved outcomes a patient can achieve with pre-surgical weight loss include shorter surgery time, reduced complications and improved weight loss in the longer term. Kelli drew upon the body of evidence from more established surgical


practice in Australia and the US to highlight the key studies and learnings that practice can be based on.


The second speaker, Jennie Taylor, Specialist Bariatric Dietitian, Spire Hospital, focused on the dietitian’s role in managing the increased risk of post operative micronutrient deficiencies in bariatric patients. Jennie considered the evidence base for assessing patients’ risk of deficiencies and concluded that purely restrictive procedures are less likely to cause long term vitamin and mineral deficiencies but decreased dietary intake, food avoidance and intolerance can mean that patients are still at risk. Jennie’s talk highlighted that pre existing nutritional deficiencies are common in the bariatic patient population and therefore identifying and treating these problems prior to surgery must be a priority. She recommended a comprehensive pre operative nutritional assessment and full biochemistry profile. She concluded by recommending that close post operative monitoring by a specialist bariatric MDT means that deficiencies can be identified early, and monitored accordingly.


treated


Conference for me was the masterly overview provided by Professor Bozzetti on nutritional management both pre and post operatively, whilst the whole conference once again provided an extremely valuable update and reconfirmation of knowledge.”


Bariatric Surgery –


A life-saver Ruth Newton, Chair of the Calea sponsored symposium on home parenteral nutrition (HPN) and Chair of the Education Committee, said: “Bariatric surgery is an unfortunate necessity in our society today but is in many cases a life saver. However, like many aspects of healthcare, it must be delivered by appropriate specialists in the field to prevent complications such as intestinal failure. These patients already have lots of co- morbidities which are life threatening without the added pressures inherent with poor nutritional status.”


Symposium 4 on first day of Conference focused on the requirement for appropriate training to help ensure all staff coming into contact with patients requiring HPN have all the competencies required to reduce complications and improve outcomes. “It’s important,” continued Ruth, “to acknowledge that even with the best of care that a long recovery is inevitable with these patients which has huge implications for costs and allocation of resources. However, the proposed restructuring of commissioning, which has been influenced positively by BAPEN and BIFA, will result in direct funding of specialist services and deliver the best care for our patients.”


BAPEN In Touch No.59 December 2010 8


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