BACKGROUND:In the United States, beta-lactam allergy labels (BLAL) are documented in 9%-16% of hospitalized patients and associated with worse clinical outcomes such as increased mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and use of alternative antibiotics, providing an incentive for broad delabeling protocols. In Europe, BLAL prevalences are lower (0.6%-5%) and the association with clinical outcomes insufficiently explored. Therefore, we assessed the association between BLAL and penicillin allergy label (PenAL) and clinical outcomes and antibiotic use in hospitalized patients in Belgium. METHODS:Retrospective population-based cohort study of all patients admitted to the University Hospitals Leuven between 2010 and 2018 for pneumonia, pyelonephritis (therapeutic indications), or appendectomy, coronary artery bypass grafting, total knee or hip replacement (prophylactic indications) or heart, kidney, liver, or lung transplantation (mixed indications). Multivariable regression analysis was performed, using BLAL or PenAL as independent variable, and age, gender, Charlson Comorbidity Index, and diagnosis as a priori hypothesized confounders. RESULTS:We included 21,999 patients accounting for 23,842 admissions. A BLAL was recorded in 1394 (6.3%) patients, with 1113 (5.1%) having an unspecified PenAL. An increased use of next-line antibiotics was observed among patients with BLAL or PenAL. However, BLAL or PenAL were not associated with altered in-hospital or 3-month post-hospitalization mortality, LOS or ICU admission. CONCLUSION:Despite altered antibiotic use, we observed no association of BLAL or PenAL with clinical outcome parameters, highlighting regional differences and limiting transferability of non-EU findings to guide EU delabeling protocols.

We aimed to develop and implement dosing recommendations for antimicrobials in obese and underweight patients within an academic hospital, and assess their impact on antibiotic prescribing. A multi-step approach project was performed. First, obese and underweight patient prevalence and antimicrobial prescription frequency was determined in a point prevalence study. Second and third, a literature review and e-survey provided dosing evidence. Fourth, a consensus meeting was organized to formulate dosing recommendations. Fifth, these were implemented in our clinical validation service as six clinical rules continuously screening patients’ records for potentially inappropriate prescriptions (PIPs). Uptake was evaluated by documenting the number of advices and acceptance rate. Last, an interrupted time series analysis (ITS) compared pre- and post-implementation periods to measure the impact of the intervention on residual PIPs/day. A residual PIP was defined as a PIP which persisted up to 48 h. First, 41

Background: Bedside clinical pharmacy prevents drug-related problems, but is not feasible in many countries due to limited resources. Hence, clinical rules using structural information in the electronic health record can help identifying potentially inappropriate prescriptions (PIPs). We aimed to develop and implement a risk-based clinical pharmacy service and evaluate its impact on prescribing at the trauma surgery ward. Methods: The proportion of residual PIPs per day, i.e. the number of PIPs that persisted up to 24 h after pharmacist intervention divided by the number of PIPs at T0, was evaluated before and after implementation of the intervention in an interrupted time series analysis. The pre-intervention cohort received usual pharmacy services, i.e. a 0.3 FTE clinical pharmacist trainee. Fifteen clinical rules, targeting antimicrobial, anticoagulant and analgesic therapy were implemented in the post-intervention period. The pre-intervention period was compared to two post-intervention scenarios: A) clinical rule alerts reviewed by a 0.3 FTE clinical pharmacist trainee; and B) clinical rule alerts reviewed daily for approximately 1 h by a clinical pharmacist trainee. Results: Pre-intervention, a median proportion of 67% (range 0%-100%) residual PIPs per day was observed. Scenario A showed an immediate relative reduction of 14% (p = 0.72) and scenario B a significant immediate relative reduction of 85% (p = 0.0015) in residual PIPs per day. In scenario A, recommendations were provided for 19% of clinical rule alerts, of which 67% was accepted by the surgeon within 24 h. In scenario B, recommendations were given for 56% of alerts, of which 84% was accepted. Conclusions: Using clinical rules is an effective approach to organize bedside clinical pharmacy services and improves prescribing at the trauma surgery ward. Advanced training and daily follow-up of the clinical rules are two requirements to be considered.

Introduction: Oral drug therapy may be compromised in chronic intestinal failure (CIF) because of alterations in absorption and transit. However, only scarce literature is available on which medication CIF patients take in daily life. The aim was to describe the medication used by patients with CIF on home parenteral support (PS). Methods: A medication history was obtained from adult CIF patients treated in our tertiary care CIF center, either face-to-face or by telephone interview. This included all orally and parenterally administered (prescribed and ‘over the counter’) medication and micronutrients on top of their daily supplementation with PS. Patient characteristics, degree of polypharmacy, total monthly medication cost (from a societal perspective), route of administration, formulation, drug classes and Biopharmaceutics Classification System (BCS) classes were analyzed. Patients were divided into SBS and non-SBS patient cohorts. Results: From October 2019 until December 2020, 72 patients (35 short bowel syndrome (SBS) and 37 non-SBS patients) were included. Median age and body mass index were 59.5 years [IQR 51.8-69.2] and 20.5 kg/m2 [18.9-22.7], respectively. The majority of patients (76.4%) were female. The median volume of PS per week and amount of days per week on PS were 6.0 L [4.5-11.9] and 5 days [3-7], respectively. Polypharmacy (at least five drug preparations), was seen in 85.7% of SBS and 75.7% of non-SBS patients. The median total cost per month for medication was 281.78 USD [113.66-870.97] and 175.08 USD [115.09-626.09] for SBS and non-SBS patients respectively. Both in SBS (78.0%) and non-SBS (74.9%) patients, most medication was taken orally, requiring gastrointestinal absorption of the active substance to be pharmacologically active. Most of these medications (77.0% in SBS and 80.8% in non-SBS patients) were formulated as a capsule or tablet, requiring disintegration and dissolution in the gastrointestinal tract before absorption of the active substance can take place. The top three drug classes taken by CIF patients were 1/ proton-pump inhibitors (85.7% of SBS and 67.6% of non-SBS patients), 2/ vitamin D (57.1% of SBS patients) or acetaminophen (46.0% of non-SBS patients) and 3/ anti-motility medication (54.3% of SBS patients) or laxatives/benzodiazepines (each in 37.8% of non-SBS patients). About 25% of the medication taken by SBS and non-SBS patients was medication of BCS class I, characterized by a good permeability and solubility. Conclusion: Polypharmacy is highly prevalent in SBSB and non-SBS CIF patients. Most medication is taken orally in formulations requiring disintegration, dissolution and gastrointestinal absorption, which could be compromised in CIF. More research is needed to investigate the clinical effects of different oral formulations in patients with CIF, as oral administration will always be preferred by healthcare professionals and patients.

Aux États-Unis, la prévalence des étiquettes d’allergie aux bêta-lactamines (« beta-lactam allergy label », BLAL) chez les patients hospitalisés se situe entre 9 et 15 %. BLAL sont associées à une augmentation de la mortalité, de la durée d’hospitalisation, de l’admission en service de soins intensifs (SSI), et de l’utilisation d’antibiotiques (AB) alternatifs. Cependant, une prévalence plus faible de BLAL, allant de 1 à 5 %, a été trouvée en Europe, et les risques associés restent inconnus. Évaluer l’association d’un BLAL avec les résultats cliniques et l’utilisation d’AB chez les patients admis pour des maladies nécessitant une antibiothérapie (pneumonie, pyélonéphrite, infections associées à une transplantation) ou antibioprophylaxie (appendicectomie, pontage aorto-coronarien, prothèse totale de genou ou de hanche). Étude de cohorte rétrospective, incluant tous les patients admis à l’Hôpital universitaire de Louvain, Belgique, entre 2010 et 2018, pour les conditions susmentionnées. L’association des BLAL avec les résultats cliniques et l’utilisation d’AB a été évaluée à l’aide d’une analyse de régression multivariée, avec la BLAL comme variable indépendante, et l’âge, le sexe, la transplantation, l’admission SSI et le diagnostic comme facteurs de confusion supposés. Au total, 15 445 patients avec 16 663 admissions ont été inclus. Les BLAL n’étaient pas associées à une augmentation de la mortalité à l’hôpital ou 3 mois après l’hospitalisation, ni à l’admission en SSI. Cependant, une durée d’hospitalisation plus longue (moyenne 19 (±34) vs 16 (±24) jours ; hazard ratio pour décharge 0,94, 95 %CI [0,87–0,99], p = 0,017) et une utilisation plus importante des AB de deuxième intention ont été observées. Les BLAL ont été associées à une augmentation de la durée de l’hospitalisation et à une modification de l’utilisation des AB, mais pas à une augmentation de la mortalité ou de l’admission SSI. Une meilleure connaissance des risques associés aux BLAL est indispensable pour une évaluation correcte de la balance bénéfices risques dans les protocoles de désétiquetage, adaptés à un contexte local et spécifique à la maladie.

BACKGROUND:Oral drug therapy may be compromised in chronic intestinal failure (IF) because of alterations in absorption and transit. Only scarce literature is available on which medication patients with chronic IF take in daily life. The aim was to describe the medication use in these patients.METHODS:A medication history was obtained from adults with chronic IF treated in our tertiary care IF center. Degree of polypharmacy, drug classes, Biopharmaceutics Classification System classes, route of administration, and formulation of drugs were analyzed.RESULTS:From October 2019 until December 2020, 72 patients (35 patients with short bowel syndrome [SBS] and 37 patients without SBS) were included. Polypharmacy was seen in 85.7% of patients with SBS and 75.7% of patients without SBS. The top three drug classes were proton-pump inhibitors, vitamin D or acetaminophen, and antimotility medication or laxatives/benzodiazepines. Approximately 25% of the drugs were classified as Biopharmaceutics Classification System class I drugs. In patients with SBS (78%) and patients without SBS (74.9%), most medication was taken orally, requiring gastrointestinal absorption of the active substance to be pharmacologically active. Most of these medications (77% in patients with SBS and 80.8% in patients without SBS) were formulated as a capsule or tablet, requiring disintegration and dissolution in the gastrointestinal tract before absorption can take place.CONCLUSION:Polypharmacy was observed in most patients with chronic IF. Most medication was taken orally in formulations requiring disintegration, dissolution, and gastrointestinal absorption, which could be compromised in chronic IF.

Auto-immuunaandoeningen hebben een zeer uiteenlopende presentatie en de interpretatie van auto-immuunserologie is, gezien de vele valkuilen, een uitdaging. Deze factoren maken het stellen van een correcte diagnose erg complex. Dit e-book bundelt daarom de belangrijkste artikels, die in 2021-2022 werden gepubliceerd in het Tijdschrift voor Geneeskunde en Gezondheidszorg rond dit thema. De auteurs reiken u […]

Three-dimensional distribution gradients of intracerebrally injected tritiated dopamine were calculated on the basis of concentrations in multiple punch-samples from sequential sections of Macaca fascicularis brain tissue. The monkey was pretreated systemically with a monoamine oxidase inhibitor to retard elimination. Gradients were best fit by cubic exponential equations relating concentration to distance from the center of the site. The concentration at the center, total amount of label, and total extent of the site injected just before perfusion were consistent with initial distribution in the extracellular space, if the volume fraction of the latter is estimated at 20%. The extent of distribution was distinctly greater in the mediolateral and dorsoventral dimensions than in the anteroposterior dimension. The total amount of label near the site decreased rapidly in the first few minutes after injection, then much more slowly, reaching about 30% of the injected amount after 2 h. Its distribution within the site changed steadily, the outer boundary gradually expanding and the peak at the center gradually decreasing. This pattern was consistent with an initial rapid dispersion by injection pressure and an initial loss of tritiated dopamine due to disruption of the blood-brain barrier at the center of the site, followed by a steady expansion of the site driven by diffusion and bulk flow.

Medication errors with methotrexate: new insights into an old drug Methotrexate (MTX) was first used in 1948 to treat childhood leukaemia. Nowadays, it is used for the treatment of inflammatory diseases, such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis and inflammatory bowel disease. MTX is a folic acid antagonist that binds dihydrofolate reductase and thereby inhibits the synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) and proteins. As an incontestable cornerstone in the treatment of RA, MTX should be started as soon as RA is diagnosed. The primary goal of the treatment is rapid and effective disease control to prevent long-term damage to the joints. For the treatment of patients with RA, the usual starting dose of MTX is 7.5-10 mg per week. Based on the clinical response, the dose could be increased to reach the optimal dose. The most common adverse drug events of MTX therapy are gastro-intestinal intolerance, haematological abnormalities, alopecia, hepatotoxicity and pulmonary toxicity. Overall, MTX is well tolerated. However, fatal cases of MTX intoxication have been reported in literature, mainly due to the daily intake and thus overdose of MTX. Despite the widespread experience with MTX, medication errors still occur with a risk of potentially severe adverse drug events. Clinical pharmacy interventions aim to detect these medication errors in inpatients. Based on a case series within a hospital population, the most common medication errors with MTX are presented. Subsequently, specific interventions to optimize medication safety with MTX therapy are described. The implementation of a specific chemotherapy module in the computerized physician order entry and clinical pharmacy interventions, such as medication reconciliation, the engagement of clinical pharmacists on hospital wards as part of the interdisciplinary team and prescription validation based on clinical rules, can contribute to a safer use of MTX.

ObjectivesEarly switch from intravenous to oral therapy of bioequivalent drugs has major advantages but remains challenging. At our hospital, a basic clinical rule was designed to automatically alert the physician to review potential intravenous to oral switch (IVOS). A rather low acceptance rate was observed. In this study, we aimed to develop, validate and investigate the effect of more advanced clinical rules for IVOS, as part of a centralised pharmacist-led medication review service.Design and settingA quasi-experimental study was performed in a large teaching hospital in Belgium using an interrupted time series design.InterventionA definite set of 13 criteria for IVOS, focusing on the ability of oral absorption and type of infection, was obtained by literature search and validated by a multidisciplinary expert panel. Based on these criteria, we developed a clinical rule for paracetamol and one for ten bioequivalent antibiotics to identify patients with potentially inappropriate intravenous prescriptions (PIVs). Postintervention, the clinical rule alerts were reviewed by pharmacists, who provided recommendations to switch in case of eligibility.Primary and secondary outcome measuresA regression model was used to assess the impact of the intervention on the number of persistent PIVs between the preintervention and the postintervention period. The total number of recommendations, acceptance rate and financial impact were recorded for the 8-month postintervention period.ResultsAt baseline, a median number of 11 (range: 7–16) persistent PIVs per day was observed. After the intervention, the number reduced to 3 (range: 1–7) per day. The advanced IVOS clinical rules showed an immediate relative reduction of 79% (incidence rate ratio=0.21, 95% CI 0.13 to 0.32; p<0.01) in the proportion of persistent PIVs. No significant underlying time trends were observed during the study. Postintervention, 1091 recommendations were provided, of which 74.1% were accepted, resulting in a total 1-day cost saving of €4648.35.ConclusionsWe showed the efficacy of advanced clinical rules combined with a pharmacist-led medication review for IVOS of bioequivalent drugs.

Abstract Background Fracture-related infection (FRI) is a challenging complication in musculoskeletal trauma surgery and often complicates the management of open fractures. The CDC currently advocates a surveillance period of 90 days after fracture fixation, but it is unclear what duration of follow-up constitutes adequate surveillance for FRI. Inadequate follow-up will underestimate infections and, in clinical research, will make any interventions studied appear better than they really are, thereby resulting in misleading conclusions. Questions/purposes (1) What is the timing of FRI onset in patients with open fractures? (2) What is the proportion of FRIs captured when follow-up is limited to 90 days postoperatively versus when follow-up is extended to 1 year? Methods This is a secondary analysis of patient data from a previous retrospective cohort study that investigated whether the duration of perioperative antibiotic prophylaxis was independently associated with FRI in patients with open fractures. Of the 530 eligible patients in the source study, 3% (14) died. Of the remaining 516 patients, 97% (502) patients with 559 long-bone open fractures had 2 years of follow-up constituted the base cohort. Forty-seven fractures in 46 patients were complicated by FRI and were the focus of this secondary analysis. Medical records were reviewed in detail specifically for the current study. Seventy-eight percent (36 of 46) of patients were male, and the mean ± SD age was 42 ± 16 years. The most common mechanism of injury was a motor vehicle accident (63% [29 of 46] of patients), and the tibia was the most involved site (53% [25 of 47] of fractures). The median (interquartile range) time to debridement was 3.0 hours (IQR 2.0 to 4.0). FRIs developed in 3% (7 of 247) of Type I open fractures, 7% (11 of 164) of Type II, 17% (18 of 107) of Type IIIA, 29% (9 of 31) of Type IIIB, and 20% (2 of 10) of Type IIIC open fractures. Each clinic visit of each patient was reviewed, and data about the time of onset of any symptoms and signs suggesting or confirming an FRI, as reported by patients and/or determined by treating surgeons, were recorded. The proportions of FRIs with onset by specific time periods were determined. A Kaplan-Meier survival analysis was performed, and the FRI event rates with 95% confidence intervals were calculated. Results The median (IQR) time to the onset of FRI was 52 days (IQR 15 to 153). Follow-up of 90 days captured only 64% (30 of 47) of FRIs, whereas follow-up of 1 year captured 89% (42 of 47) of FRIs. The proportion of FRIs with onset within 1 year increased to 95% (42 of 44) in the presence of an already healed fracture. Conclusion Follow-up of 90 days after the management of an open long-bone fracture is inadequate for postoperative surveillance, especially for research purposes. Clinical research on interventions would report results appearing to be much better than they really are, potentially resulting in misleading conclusions. Follow-up of 1 year is preferable because most FRIs will develop before that time, especially when fracture union has occurred. A small percentage of patients may still develop infections beyond the first year after the management of an open fracture. The risk of missing these infections by not extending follow-up beyond 1 year must be balanced against the additional logistical burden. Future prospective multicenter studies and registries with long-term patient follow-up would help clarify this issue. Level of Evidence Level III, diagnostic study.

Objectives: Inappropriate prescribing of antimicrobials in hospitals contributes to the emergence of resistance and adverse drug events. To support antimicrobial stewardship (AMS), clinical decision rules focusing on antimicrobial therapy were implemented in the 'Check of Medication Appropriateness' (CMA). The CMA is a hospital-wide pharmacist-led medication review service consisting of a clinical rule-based screening for potentially inappropriate prescriptions (PIPs). We aimed to investigate the impact of the CMA on antimicrobial prescribing. Methods: An interrupted time series study was performed at the University Hospitals Leuven. The pre-implementation cohort was exposed to standard-of-care AMS. Afterwards, an AMS-focused CMA comprising 41 specific clinical rules, targeting six AMS objectives, was implemented in the post-implementation period. A regression model was used to assess the impact of the intervention on the number of AMS-related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the 2 year post-implementation period. Results: Pre-implementation, a median proportion of 75% (range: 33%-100%) residual PIPs per day was observed. After the CMA intervention, the proportion was reduced to 8% (range: 0%-33%) per day. Use of clinical rules resulted in an immediate relative reduction of 86.70% (P < 0.0001) in AMS-related residual PIPs. No significant underlying time trends were observed during the study period. Post-implementation, 2790 recommendations were provided of which 81.32% were accepted. Conclusions: We proved that the CMA approach reduced the number of AMS-related residual PIPs in a highly significant and sustained manner, with the potential to further expand the service to other AMS objectives.

Parenteral nutrition (PN) is recommended in patients nutritionally at risk and unable to receive oral or enteral nutrition. A standardized electronic PN order format could enhance appropriate PN prescribing. We developed the OLIVE TREE (Offering guidance and Learning to prescribers to Initiate PN using a Validated Electronic decision TREE), embedded in our electronic health record. We aimed to evaluate its validity and impact on physicians’ prescribing behavior. A non-randomized before-after study was carried out in a tertiary care center. The OLIVE TREE comprises 120 individual items. A process validation was performed to determine interrater agreement between a pharmacist and the treating physician. To estimate the proportion of patients for whom the OLIVE TREE had an effective and potential impact on physicians’ prescribing behavior, a proof of concept study was conducted. The proportion of patients for whom PN was averted and the proportion of decisions not in line with the recommendation were also calculated. The process validation in 20 patients resulted in an interrater agreement of 95.0%. The proof of concept in 73 patients resulted in an effective and potential impact on prescribing behavior in 50.7% and 79.5% of these patients, respectively. Initiation of PN was not averted and recommendations of the OLIVE TREE were overruled in 42.5% of the patients. Our newly developed OLIVE TREE has a good process validity. A substantial impact on prescribing behavior was observed, although initiation of PN was not avoided. In the next phase, the decision tree will be implemented hospital-wide.

Rationale: International guidelines state that clinical decision support enhances appropriate prescribing of parenteral nutrition (PN), leading to increased quality of care and cost savings. We aimed to develop, validate and analyse an electronic PN decision tree (ePNDT) embedded in our electronic health record.

Rationale: The ESPEN guidelines suggests the follow-up of chronic intestinal failure (IF) patients by a multidisciplinary team. However, the effect on outcomes is only sparsely documented. Methods: We performed a review of prospectively collected data comparing the outcome of benign chronic IF before (2016) and after (2019) the implementation of a multidisciplinary team (gastroenterologists, IF nurses and dietitians, pharmacists and vascular access nurses) in our center: LIFT (Leuven Intestinal Failure and Transplantation). The team also implemented evidence based changes to the homecare protocols, including primary prevention of catheter-related bloodstream infections (CRBSI) by taurolidine locks, needle-free connectors and passive disinfection caps. Data were collected on the incidence of CRBSI, parenteral nutrition (PN)-related admissions and self-administration of PN. Results: The number of patients increased significantly from 77 (22 males; 57.8±15.4ys) in 2016 to 137 in 2019 (48 males; 56.0±15.9ys) with a similar distribution of IF subgroups (55 vs. 50% short bowel syndrome). We observed a significant decline in CRBSI (0.7 vs 0.14/1000 catheter days, p= 0.0011) and the number of PN-related hospital days (1.12 vs 0.47/100 catheter days, p= < 0.0001). Finally, the proportion of patients who are fully or partially independent for the PN-administration increased (66.2 vs 80.3%, p=0.031) after the creation of LIFT. Conclusions: We have seen an important increase in referrals from other specialties and hospitals since the creation of a multidisciplinary IF team. Different catheter care protocols were implemented together with an educational approach strongly promoting self-efficacy. More research is needed to attribute the improved outcome to the different measures but it is clear that without a multidisciplinary team most of these strategies could not have been implemented.

A correction to this paper has been published: https://doi.org/10.1007/s00402-021-03847-7

Background and importance Closed femoral neck fractures after low impact trauma in the elderly are often treated with hemiarthroplasty. In this setting, the literature with respect to prosthetic joint infection (PJI) is scarce. Aim and objectives The objectives of this study were to investigate the incidence of PJI and the impact of the number of perioperative antimicrobial prophylaxis (PAP) administrations. Furthermore, in this population, risk factors for PJI were identified. Material and methods In this retrospective monocentric study, medical files of elderly (≥75 years) trauma patients with closed femoral neck fractures and treated with a hemiarthroplasty, admitted between January 2006 and July 2017, were evaluated. Patient follow-up was 90 days. A Cox proportional hazards regression analysis with forward step was applied. Results were considered statistically significant if p<0.05. Results A consecutive series of 745 patients (mean age 85±5 years, 221 (29.7%) men) were treated with a hemiarthroplasty. Within 90 postoperative days, 13 (1.7%) patients developed a PJI and 120 (16.1%) died due to reasons other than infection. The applied PAP regimens consisted of intravenous cefazoline or clindamycin. Single and repeated PAP administrations (every 8 hours) were observed. Patients who developed a PJI received a median of 1 (IQR 1–2) PAP administration, which was not significantly different compared with PAP administrations in patients that did not develop a PJI (1 (IQR 1–3)) (HR=0.236 (95% CI 0.032 – 1.745); p=0.157). Higher body weight (HR=1.05 (95% CI 1.008–1.094); p=0.020), systemic corticoid use (HR=4.790 (95% CI 1.275–17.997; p=0.020) and the need for transfer to the intensive care unit (ICU) for reasons other than infection (HR=8.692 (95% CI 2.353–32.106; p=0.001) were independently associated with the development of a PJI within 90 days. Conclusion and relevance In this fragile trauma population, the observed 1.7% PJI incidence within 90 days was low compared with the incidence rate of 3.4–4.5% in the literature. Our preliminary data showed that the number of PAP administrations did not influence the risk of PJI. Patients with a higher body weight, with systemic corticoid use or with postoperative ICU transfer should be monitored closely for infection. References and/or acknowledgements No conflict of interest.

Background and importance The initiation of home parenteral nutrition (HPN) in patients with advanced malignancy is a highly controversial topic. Guidelines recommend reserving this therapy for patients with an expected survival of longer than 2–3 months. Administering HPN in patients with a shorter survival probably has little benefit, while creating the risk of PN related complications. As HPN in advanced cancer patients is becoming increasingly common in our hospital, we wanted to investigate whether current practices are supported by the rational use of HPN. Aim and objectives Firstly, this study sought to investigate the proportion of patients with advanced cancer receiving HPN in our hospital, surviving for longer than 2–3 months. Furthermore, we wanted to investigate whether the application of survival prediction models could improve estimation of the length of patient survival. Material and methods Survival proportions of 250 patients with advanced gastrointestinal malignancy receiving HPN in our hospital during 2008–2016 were examined. Additionally, agreement was assessed between observed survival times and the current inhospital survival prediction method (ie, physician’s clinical judgement) or survival estimation by a published prediction nomogram. Moreover, through the use of multivariable logistic regression on variables gathered from the studied patient set, both a 2 and 3 month survival prediction model were constructed and validated. Results The results showed that a relatively low proportion of patients actually met the proposed survival criteria (65.2% and 46.4% for 2 and 3 month survival lengths, respectively). Concerning survival prediction, clinicians predominantly tended to overestimate survival length. Furthermore, application of the published nomogram did not improve survival prediction. Therefore, de novo 2 and 3 month survival prediction models were developed. The 2 month prediction model consisted of four variables: Karnofsky performance score (KPS), Glasgow prognostic score (GPS), gender and serum sodium, while the 3 month model consisted of three variables: KPS, GPS and serum urea. Validation of constructed survival prediction models in an independent set of 99 patients showed discriminatory abilities that were comparable, but not superior, to the results obtained with the aforementioned survival prediction nomogram. Conclusion and relevance This investigation showed that correct patient survival prediction remains an intrinsically difficult exercise. In order for our constructed models to have clinical utility, further improvement is needed, possibly through the inclusion of additional predictors for survival. References and/or acknowledgements No conflict of interest.

Rationale: The ESPEN guidelines suggest the follow-up of chronic intestinal failure (IF) patients by a multidisciplinary team. However, the effect on outcomes is only sparsely documented.