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-2.7035 -1.6748 -1.8837 c -1.6748 -.4602 -.9047 .5463 .0855 .5463 c .8864 .5463 1.2163 .0144 1.2163 -.7406 c 1.2163 -2.2145 .3546 -3.1562 -.5624 -3.1562 c f Q q 1 0 0 1 518.986 720.662 cm 0 0 m -.6663 0 -1.1124 -.8774 -1.1124 -1.7759 c -1.1124 -2.308 -.9291 -2.6026 -.4706 -2.6026 c .1223 -2.6026 .6418 -1.855 .6418 -.8127 c .6418 -.2878 .4402 0 0 0 c h -.5624 -3.1562 m -1.3264 -3.1562 -1.6748 -2.7035 -1.6748 -1.8837 c -1.6748 -.4602 -.9047 .5463 .0856 .5463 c .8864 .5463 1.2163 .0144 1.2163 -.7406 c 1.2163 -2.2145 .3546 -3.1562 -.5624 -3.1562 c f Q q 1 0 0 1 522.409 720.691 cm 0 0 m -.9047 0 -1.2593 -1.0997 -1.2593 -1.9842 c -1.2593 -2.4514 -1.1371 -2.6383 -.9475 -2.6383 c -.373 -2.6383 .2505 -1.2076 .3911 -.3521 c .4338 -.0645 l .3116 -.0283 .171 0 0 0 c h .6844 -1.833 m .6049 -2.329 .5255 -2.8253 .4827 -3.1199 c -.0551 -3.1199 l -.0063 -2.8109 .1099 -2.3363 .2933 -1.6678 c .2809 -1.6604 l .0609 -2.2141 -.3974 -3.192 -1.1371 -3.192 c -1.577 -3.192 -1.8156 -2.8612 -1.8156 -2.106 c -1.8156 -.7904 -1.2349 .511 .0916 .511 c .2444 .511 .3667 .4966 .5194 .4677 c .7822 2.1287 l 1.3262 2.1287 l .6844 -1.833 l f Q q 1 0 0 1 527.659 717.571 cm 0 0 m -.538 0 l -.165 2.2863 l -.0734 2.8469 -.1589 3.0916 -.4341 3.0916 c -.9965 3.0916 -1.6198 1.6894 -1.7604 .8053 c -1.8889 0 l -2.4266 0 l -2.121 1.8694 l -2.0416 2.3797 -1.9316 3.0484 -1.8522 3.5731 c -1.3204 3.5731 l -1.3571 3.3358 -1.4426 2.926 -1.6565 2.1639 c -1.6443 2.1639 l -1.3571 2.9189 -.874 3.6448 -.2384 3.6448 c .324 3.6448 .5134 3.1776 .3972 2.4301 c 0 0 l f Q q 1 0 0 1 531.106 717.571 cm 0 0 m -.538 0 l -.4952 .2373 -.4157 .6471 -.2017 1.4092 c -.214 1.4092 l -.5012 .6542 -.9781 -.0721 -1.6137 -.0721 c -2.1761 -.0721 -2.3718 .3955 -2.2495 1.1431 c -1.8582 3.5731 l -1.3141 3.5731 l -1.6871 1.2869 l -1.7787 .7262 -1.6932 .4816 -1.4243 .4816 c -.8619 .4816 -.2324 1.8834 -.0917 2.7678 c .0366 3.5731 l .5745 3.5731 l 0 0 l f Q q 1 0 0 1 534.095 720.641 cm 0 0 m -.8252 0 l -1.1248 -1.8694 l -1.2103 -2.4227 -1.1491 -2.5739 -.8496 -2.5739 c -.6785 -2.5739 -.5502 -2.5523 -.4278 -2.5161 c -.4645 -3.0554 l -.6418 -3.0986 -.8557 -3.1273 -1.033 -3.1273 c -1.6564 -3.1273 -1.8154 -2.7822 -1.6871 -1.9698 c -1.3632 0 l -1.9804 0 l -1.8949 .5033 l -1.2837 .5033 l -1.0941 1.6608 l -.5256 1.8116 l -.7396 .5033 l .0856 .5033 l 0 0 l f Q q 1 0 0 1 536.326 720.583 cm 0 0 m -.5623 .1865 -1.1614 -1.2152 -1.3204 -2.2072 c -1.4487 -3.0125 l -1.9866 -3.0125 l -1.412 .5607 l -.8865 .5607 l -.9353 .2513 -1.0208 -.1296 -1.1981 -.755 c -1.1859 -.762 l -.8435 .1075 -.4768 .7402 .11 .6254 c 0 0 l f Q q 1 0 0 1 537.462 721.733 cm 0 0 m -.2017 0 -.3483 .1871 -.3361 .4098 c -.33 .6541 -.1527 .8412 .0491 .8412 c .2445 .8412 .3974 .6615 .3853 .4388 c .373 .1941 .1957 0 0 0 c h -.4522 -4.1626 m -.99 -4.1626 l -.4094 -.5895 l .1285 -.5895 l -.4522 -4.1626 l f Q q 1 0 0 1 540.005 720.641 cm 0 0 m -.8253 0 l -1.1246 -1.8694 l -1.2105 -2.4227 -1.1492 -2.5739 -.8497 -2.5739 c -.6786 -2.5739 -.5501 -2.5523 -.428 -2.5161 c -.4646 -3.0554 l -.6421 -3.0986 -.8559 -3.1273 -1.033 -3.1273 c -1.6565 -3.1273 -1.8154 -2.7822 -1.6871 -1.9698 c -1.363 0 l -1.9807 0 l -1.8949 .5033 l -1.2836 .5033 l -1.0941 1.6608 l -.5257 1.8116 l -.7395 .5033 l .0855 .5033 l 0 0 l f Q q 1 0 0 1 541.239 721.733 cm 0 0 m -.2015 0 -.3484 .1871 -.3359 .4098 c -.33 .6541 -.1525 .8412 .049 .8412 c .2446 .8412 .3973 .6615 .3851 .4388 c .3729 .1941 .1956 0 0 0 c h -.4521 -4.1626 m -.9901 -4.1626 l -.4095 -.5895 l .1287 -.5895 l -.4521 -4.1626 l f Q q 1 0 0 1 543.471 720.662 cm 0 0 m -.6663 0 -1.1127 -.8774 -1.1127 -1.7759 c -1.1127 -2.308 -.9291 -2.6026 -.4708 -2.6026 c .1222 -2.6026 .6417 -1.855 .6417 -.8127 c .6417 -.2878 .4401 0 0 0 c h -.5624 -3.1562 m -1.3263 -3.1562 -1.6749 -2.7035 -1.6749 -1.8837 c -1.6749 -.4602 -.9047 .5463 .0853 .5463 c .8863 .5463 1.2163 .0144 1.2163 -.7406 c 1.2163 -2.2145 .3544 -3.1562 -.5624 -3.1562 c f Q q 1 0 0 1 547.523 717.571 cm 0 0 m -.5377 0 l -.165 2.2863 l -.0732 2.8469 -.1587 3.0916 -.4341 3.0916 c -.9962 3.0916 -1.6198 1.6894 -1.7601 .8053 c -1.8886 0 l -2.4266 0 l -2.121 1.8694 l -2.0415 2.3797 -1.9314 3.0484 -1.8519 3.5731 c -1.3202 3.5731 l -1.3569 3.3358 -1.4424 2.926 -1.6564 2.1639 c -1.6442 2.1639 l -1.3569 2.9189 -.874 3.6448 -.2382 3.6448 c .324 3.6448 .5135 3.1776 .3974 2.4301 c 0 0 l f Q q 1 0 0 1 550.334 720.691 cm 0 0 m -.9047 0 -1.2591 -1.0997 -1.2591 -1.9842 c -1.2591 -2.4514 -1.1371 -2.6383 -.9474 -2.6383 c -.373 -2.6383 .2505 -1.2076 .3911 -.3521 c .4338 -.0645 l .3116 -.0283 .171 0 0 0 c h .4829 -3.1199 m -.0612 -3.1199 l -.0061 -2.8109 .1099 -2.3363 .2935 -1.6678 c .2812 -1.6604 l .0611 -2.2141 -.3974 -3.192 -1.1371 -3.192 c -1.577 -3.192 -1.8154 -2.8612 -1.8154 -2.106 c -1.8154 -.7904 -1.2349 .511 .0916 .511 c .4401 .511 .7641 .4677 1.045 .4029 c .7211 -1.5957 .6112 -2.2642 .4829 -3.1199 c f Q q 1 0 0 1 552.363 717.571 cm 0 0 m -.5378 0 l .3118 5.2485 l .8498 5.2485 l 0 0 l f Q q 1 0 0 1 556.959 720.533 cm 0 0 m -.1652 .0865 -.3425 .1366 -.5563 .1366 c -1.3265 .1366 -1.6873 -.884 -1.6873 -1.6964 c -1.6873 -2.0705 -1.5834 -2.4516 -1.0516 -2.4516 c -.8131 -2.4516 -.5563 -2.3868 -.3669 -2.2788 c -.4034 -2.8469 l -.6174 -2.9406 -.8989 -3.0194 -1.2044 -3.0194 c -1.9929 -3.0194 -2.2618 -2.5161 -2.2618 -1.8406 c -2.2618 -.4742 -1.6078 .6689 -.5198 .6689 c -.2691 .6689 -.0673 .6256 .122 .5609 c 0 0 l f Q q 1 0 0 1 559.025 720.691 cm 0 0 m -.9047 0 -1.2592 -1.0997 -1.2592 -1.9842 c -1.2592 -2.4514 -1.1369 -2.6383 -.9473 -2.6383 c -.3728 -2.6383 .2507 -1.2076 .3912 -.3521 c .4338 -.0645 l .3118 -.0283 .1712 0 0 0 c h .4828 -3.1199 m -.0612 -3.1199 l -.0061 -2.8109 .1101 -2.3363 .2935 -1.6678 c .2813 -1.6604 l .0613 -2.2141 -.3972 -3.192 -1.1369 -3.192 c -1.5769 -3.192 -1.8153 -2.8612 -1.8153 -2.106 c -1.8153 -.7904 -1.2347 .511 .0917 .511 c .4403 .511 .7642 .4677 1.0452 .4029 c .7213 -1.5957 .6113 -2.2642 .4828 -3.1199 c f Q q 1 0 0 1 562.503 720.583 cm 0 0 m -.5622 .1865 -1.1611 -1.2152 -1.3202 -2.2072 c -1.4485 -3.0125 l -1.9865 -3.0125 l -1.4119 .5607 l -.8862 .5607 l -.9352 .2513 -1.0207 -.1296 -1.198 -.755 c -1.1857 -.762 l -.8434 .1075 -.4767 .7402 .1101 .6254 c 0 0 l f Q q 1 0 0 1 564.251 720.72 cm 0 0 m -.4829 0 -.8069 -.496 -.9475 -1.1 c -.0061 -1.0566 .4097 -.8337 .4097 -.4025 c .4097 -.1439 .2446 0 0 0 c h -1.0148 -1.5744 m -1.033 -1.6824 -1.0453 -1.862 -1.0453 -1.9915 c -1.0453 -2.5449 -.8802 -2.6887 -.3914 -2.6887 c -.1039 -2.6887 .2017 -2.6096 .4645 -2.4804 c .4645 -2.9981 l .1713 -3.1345 -.1833 -3.2136 -.5807 -3.2136 c -1.2775 -3.2136 -1.6014 -2.8613 -1.6014 -2.0559 c -1.6014 -.6686 -.9475 .4889 .0611 .4889 c .7092 .4889 .9537 .1008 .9537 -.3234 c .9537 -1.093 .2872 -1.5168 -1.0148 -1.5744 c f Q EMC /Artifact <>BDC q 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n 1 .89 0 0 k q 1 0 0 1 298.526 572.978 cm 0 0 m 257.014 0 l 258.58 0 259.849 -1.2693 259.849 -2.835 c 259.849 -226.772 l 259.849 -228.338 258.58 -229.607 257.014 -229.607 c -257.014 -229.607 l -258.58 -229.607 -259.849 -228.338 -259.849 -226.772 c -259.849 -2.835 l -259.849 -1.2693 -258.58 0 -257.014 0 c h f* Q EMC /P <>BDC BT /TT2 1 Tf 11 0 0 11 61.2931 543.0913 Tm 0 0 0 0 k .0001 Tc .0694 Tw (Patients receiving home parenteral support \(HPS\) require regular review by the multidisciplinary)Tj ET EMC /P <>BDC BT 11 0 0 11 535.6317 543.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 527.0913 Tm -.005 Tc -.0164 Tw (nutrition support team \(NST\) either face-to-face in a clinic or remotely by a telephone or a video link)Tj ET EMC /P <>BDC BT 11 0 0 11 535.5743 527.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 511.0913 Tm .0084 Tw [(\(virtual appointment\). )55.1(After discharge from hospital a review follow-up clinic appointment is ideally)]TJ ET EMC /P <>BDC BT 11 0 0 11 535.629 511.0913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 495.0913 Tm .0028 Tc .0667 Tw (given within the first 4-6 weeks and thereafter at regular intervals dependent on clinical stability)Tj ET EMC /P <>BDC BT 11 0 0 11 535.6282 495.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 479.0913 Tm -.0222 Tc -.0345 Tw [(\(usually every 3-6 months lasting 20-30 minutes\). )18(The healthcare professionals will monitor the patient)18(s)]TJ ET EMC /P <>BDC BT 11 0 0 11 535.4626 479.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 463.0913 Tm -.0024 Tc -.0393 Tw (underlying illness \(if gastrointestinal\), hydration, nutritional, psychological and social status and any)Tj ET EMC /P <>BDC BT 11 0 0 11 535.6262 463.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 447.0913 Tm -.0366 Tw (complications. It is the forum for detecting problems, planning for the long-term, checking the goals)Tj ET EMC /P <>BDC BT 11 0 0 11 535.629 447.0913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 431.0913 Tm .039 Tw [(of treatment and for providing support. During the consultation dif)18.1(ferent team members may take)]TJ ET EMC /P <>BDC BT 11 0 0 11 535.6288 431.0913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 415.0913 Tm -.0344 Tw (the lead in the discussions \(e.g. the doctor on underlying condition, the specialist nutrition nurse on)Tj ET EMC /P <>BDC BT 11 0 0 11 535.629 415.0913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 399.0913 Tm -.0203 Tc -.0364 Tw (catheter care/problems, the dietitian on hydration/nutritional status and the pharmacist on medications\).)Tj ET EMC /P <>BDC BT 11 0 0 11 535.4613 399.0913 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 383.0913 Tm -.039 Tw [(However)55.2(, there will be much overlap. In children transition from paediatric to adult care needs to be)]TJ ET EMC /P <>BDC BT 11 0 0 11 535.6293 383.0913 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 11 0 0 11 61.2931 367.0913 Tm (carefully planned with both teams meeting together with the patient and parents/carers.)Tj ET EMC /P <>BDC BT 11 0 0 11 485.0401 367.0913 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 38.993 326.8191 Tm 1 .89 0 0 k (Key points)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 100.3348 326.8191 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 309.2499 Tm (1.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 309.2499 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 309.2499 Tm -.005 Tc [(The follow up should be by a multidisciplinary NST)18.1( \(doctor)55.2(, nurse, )]TJ ET EMC /P <>BDC BT 8 0 0 8 48.149 297.3499 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 297.3499 Tm -.005 Tc (dietitian and pharmacist\) and may be face-to-face or virtual.)Tj ET EMC /P <>BDC BT 8 0 0 8 258.6625 297.3499 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 279.7806 Tm (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 279.7806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 279.7806 Tm [(Before seeing the NST)110.8(, the patient is weighed and body mass )]TJ ET EMC /P <>BDC BT 8 0 0 8 48.109 267.8806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 267.8806 Tm (index \(BMI\) and percentage weight loss \(%WL\)/gain are calculated. )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 255.9806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 255.9806 Tm (Heart rate, postural blood pressure and temperature may be )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 244.0806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 244.0806 Tm [(recorded. )18.1(The NST)18.1( will review these, along with the current blood )]TJ ET EMC /P <>BDC BT 8 0 0 8 48.109 232.1806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 232.1806 Tm (results and any recent communications. )Tj ET EMC /P <>BDC BT 8 0 0 8 193.5113 232.1806 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 214.6113 Tm (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 214.6113 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 214.6113 Tm (When the patient is seen, current symptoms are assessed. )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 202.7113 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 202.7113 Tm (\(e.g. diarrhoea, vomiting, abdominal pain, stomal/stool output, etc.\).)Tj ET EMC /P <>BDC BT 8 0 0 8 289.1245 202.7113 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 185.142 Tm (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 185.142 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 185.142 Tm (Hydration/electrolyte status is assessed by asking about thirst, )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 173.242 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 173.242 Tm [(cramps, urine output and oedema. Ideally)74.2(, the patient will have )]TJ ET EMC /P <>BDC BT 8 0 0 8 48.109 161.342 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 161.342 Tm (measured their 24-hour urine volume on 1-2 occasions.)Tj ET EMC /P <>BDC BT 8 0 0 8 246.4371 161.342 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 143.7727 Tm (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 143.7727 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 143.7727 Tm (Nutrition status is assessed by asking about feeling cold and the )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 131.8727 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 131.8727 Tm (fitting of clothes/rings. In addition to BMI and %WL, mid-arm muscle)Tj ET EMC /P <>BDC BT 8 0 0 8 290.4293 131.8727 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 119.9728 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 119.9728 Tm (circumference \(MAC\) and triceps skinfold thickness are measured )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 108.0728 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 108.0728 Tm (to determine the mid-arm muscle circumference \(MAMC\) or are )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 96.1728 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 96.1728 Tm (measured with bioelectrical impedance analysis \(BIA\). Grip strength)Tj ET EMC /P <>BDC BT 8 0 0 8 290.437 96.1728 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 84.2727 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 84.2727 Tm (is also determined. )Tj ET EMC /P <>BDC BT 8 0 0 8 119.6988 84.2727 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 38.993 66.6035 Tm (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 66.6035 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 66.6035 Tm (Problems of a wound/stoma, or any symptoms suggesting )Tj ET EMC /P <>BDC BT 8 0 0 8 48.109 54.6035 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 50.3317 54.6035 Tm (complications of the HPS \(e.g. catheter-related blood stream )Tj ET EMC /P <>BDC BT 8 0 0 8 312.6882 329.7312 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 312.0619 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 312.0619 Tm (infection \(CRBSI\), occlusion, fracture or central vein thrombosis, )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 300.0619 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 300.0619 Tm [(intestinal failure associated liver disease \(IF)55.2(ALD\), renal disease )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 288.0619 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 288.0619 Tm (or metabolic bone problems\) are identified.)Tj ET EMC /P <>BDC BT 8 0 0 8 520.1844 288.0619 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 270.3928 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 270.3928 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 270.3928 Tm (The patient is examined \(if appropriate\). Note is made of hydration )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 258.3928 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 258.3928 Tm [(\(dry or oedematous\) and nutritional status. )18.1(The vascular/enteral )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 246.3927 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 246.3927 Tm (access and catheters/enteral tubes \(including for distal feeding\) are )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 234.3927 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 234.3927 Tm -.01 Tc (inspected, the abdomen is palpated and wound/stomas are inspected)Tj ET EMC /P <>BDC BT 8 0 0 8 556.2671 234.3927 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 222.3927 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 222.3927 Tm (\(including colour/)Tj ET EMC /P <>BDC BT 8 0 0 8 376.1843 222.3927 Tm (consistency of any stomal/stool output\).)Tj ET EMC /P <>BDC BT 8 0 0 8 516.2546 222.3927 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 204.7234 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 204.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 204.7234 Tm (The underlying diagnosis, any complications, catheter care regimen,)Tj ET EMC /P <>BDC BT 8 0 0 8 556.9838 204.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 192.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 192.7234 Tm (medication and the HPS prescription are discussed. Consideration )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 180.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 180.7234 Tm (is given to stopping/changing the HPS regimen or its composition. )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 168.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 168.7234 Tm (The risks of complications are minimised as far as is possible \(e.g. )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 156.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 156.7234 Tm [(sepsis, thrombosis, liver)55.2(, bone and renal disease\). )18.1(The underlying )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 144.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 144.7234 Tm [(diagnosis treatment plan is reviewed. )18.1(The goals of the fluid/)]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 132.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 132.7234 Tm (nutritional support are reassessed. )Tj ET EMC /P <>BDC BT 8 0 0 8 440.4799 132.7234 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 304.1843 115.054 Tm (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 115.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 115.054 Tm [(All the medicines \(oral, enteral tube, sub cutaneous, intramuscular)55.2(, )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 103.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 103.054 Tm -.01 Tc (intravenous or topical\) are reviewed including glucagon like peptide-2)Tj ET EMC /P <>BDC BT 8 0 0 8 554.9611 103.054 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 91.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 91.054 Tm [(\(GLP-2\) agonists. )18.1(The absorption of any oral drugs is considered )]TJ ET EMC /P <>BDC BT 8 0 0 8 313.3002 79.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 79.054 Tm (based on the time till maximum concentration \(Tmax\) and the )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 67.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 67.054 Tm (biopharmaceutical classification. High doses of oral medicines may )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3002 55.054 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 315.5229 55.054 Tm (be needed \(e.g. loperamide\).)Tj ET EMC /P <>BDC BT 8 0 0 8 418.2571 55.054 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 9 0 0 9 22.6772 814.1643 Tm 1 .15 0 0 k [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.78 595.29 1.417 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3571 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2006 14.3571 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 38.993 581.5861 Tm 0 0 0 .8 k [(Jeremy Nightingale, Mia Small, Michael Glynn and the BIF)55.2(A)55.2( Committee)]TJ ET EMC /P <>BDC BT 7 0 0 7 484.1076 15.0865 Tm 0 0 0 0 k (October 2023 | Page 1 of 3)Tj ET EMC Q endstream endobj 59 0 obj <>/ExtGState<>>> endobj 65 0 obj <> endobj 127 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /P <>BDC BT /TT2 1 Tf 7 0 0 7 483.5544 15.0863 Tm (October 2023 | Page 2 of 3)Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 784.0668 Tm 0 0 0 .8 k -.125 Tc (10.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 784.0668 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 784.0668 Tm [(The frequency of blood tests \(including blood counts, renal, liver)55.2(, )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 772.3468 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 772.3468 Tm -.02 Tc (bone, C-reactive protein, minerals \(includes magnesium\) and vitamins\),)Tj ET EMC /P <>BDC BT 8 0 0 8 289.5416 772.3468 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 760.6268 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 760.6268 Tm (urine sodium concentration and bone density measurement needs )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 748.9068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 748.9068 Tm (to be determined.)Tj ET EMC /P <>BDC BT 8 0 0 8 110.4507 748.9068 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 731.5175 Tm -.1992 Tc [(11)-74.2(.)]TJ ET EMC /P <>BDC BT 8 0 0 8 46.0463 731.5175 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 731.5175 Tm -.01 Tc (The psychological state, any worries, coping mechanisms, and ways)Tj ET EMC /P <>BDC BT 8 0 0 8 285.3279 731.5175 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 719.7975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 719.7975 Tm -.025 Tc [(of improving the quality of life are discussed. )55.2(An anxiety and depression)]TJ ET EMC /P <>BDC BT 8 0 0 8 287.073 719.7975 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 708.0775 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 708.0775 Tm (and/or a quality-of-life questionnaire )Tj ET EMC /P <>BDC BT 8 0 0 8 177.5991 708.0775 Tm -.015 Tc [(may be used. )18.1(The NST)18.1( will give )]TJ ET EMC /P <>BDC BT 8 0 0 8 46.0863 696.3575 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 696.3575 Tm -.015 Tc (as much)Tj ET EMC /P <>BDC BT 8 0 0 8 77.5833 696.3575 Tm 0 Tc ( support as possible in this setting \(a separate follow up )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 684.6375 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 684.6375 Tm [(discussion may be needed with one or more of the NST)18.1( on another )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 672.9175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 672.9175 Tm (occasion\). )Tj ET EMC /P <>BDC BT 8 0 0 8 86.8726 672.9175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 655.5282 Tm (1)Tj ET EMC /P <>BDC BT 8 0 0 8 40.2996 655.5282 Tm (2)Tj ET EMC /P <>BDC BT 8 0 0 8 44.2289 655.5282 Tm (.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 655.5282 Tm (Surgical plans \(if any\) including transplantation/links to other )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 643.8082 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 643.8082 Tm [(centres/units or services are reviewed. )55.2(Appropriate bowel mapping )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 632.0882 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 632.0882 Tm [(may need to be arranged. Ideally)74.2(, these discussions occur in a joint )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 620.3682 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 620.3682 Tm (clinic with the surgeons.)Tj ET EMC /P <>BDC BT 8 0 0 8 133.1186 620.3682 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 602.9789 Tm -.1 Tc (13)Tj ET EMC /P <>BDC BT 8 0 0 8 44.1489 602.9789 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 602.9789 Tm (The home care service is reviewed: )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 591.2589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 591.2589 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 591.2589 Tm (This includes the deliveries, storage of equipment, ancillaries, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 579.5389 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 579.5389 Tm (parenteral support bag and home nursing \(if required\). )Tj ET EMC /P <>BDC BT 8 0 0 8 251.0288 579.5389 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 567.8189 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 567.8189 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 567.8189 Tm [(The individual)18.1(s potential ability to learn to take care of their )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 556.0989 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 556.0989 Tm (central venous catheter and parenteral support administration )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 544.3789 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 544.3789 Tm (should be explored with the patient.)Tj ET EMC /P <>BDC BT 8 0 0 8 182.5561 544.3789 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 532.6589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 532.6589 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 532.6589 Tm (The nursing Blueteq number should be reviewed and renewed )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 520.9389 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 520.9389 Tm (accordingly \(the initial allocation of a Blueteq number for nurse )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 509.2189 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 509.2189 Tm (training is 28 hours\).)Tj ET EMC /P <>BDC BT 8 0 0 8 129.1733 509.2189 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 497.4989 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 497.4989 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 497.4989 Tm (The parenteral support Blueteq number should be reviewed )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 485.7789 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 485.7789 Tm (and renewed accordingly \(initial allocation of Blueteq number is )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 474.0589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 474.0589 Tm (for 12 months\).)Tj ET EMC /P <>BDC BT 8 0 0 8 110.4936 474.0589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 462.3389 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 462.3389 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 462.3389 Tm (The Blueteq number should be suspended if a patient has been )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 450.6189 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 450.6189 Tm [(weaned of)18.1(f parenteral support.)]TJ ET EMC /P <>BDC BT 8 0 0 8 165.0641 450.6189 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 438.8989 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 438.8989 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 438.8989 Tm (The red/amber/green \(RAG\) rating and contingency prescription )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 427.1789 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.6929 427.1789 Tm (should be assessed.)Tj ET EMC /P <>BDC BT 8 0 0 8 129.6304 427.1789 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 409.7896 Tm -.125 Tc (14)Tj ET EMC /P <>BDC BT 8 0 0 8 43.7488 409.7896 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0863 409.7896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 409.7896 Tm (All information is recorded on a local and/or national register \(e.g. )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 398.0696 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 398.0696 Tm [(Intestinal Failure Registry in England\). )18.1(The GP/referring hospital )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 386.3496 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 386.3496 Tm (should be sent a letter summing up the outcomes of the visit.)Tj ET EMC /P <>BDC BT 8 0 0 8 263.4156 386.3496 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 368.9603 Tm -.125 Tc (15)Tj ET EMC /P <>BDC BT 8 0 0 8 43.7488 368.9603 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0863 368.9603 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 368.9603 Tm (Patient should know about voluntary patient support and advocacy )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 357.2404 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 357.2404 Tm [(groups such as PINNT)18.1( and groups relevant to their underlying )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 345.5203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 345.5203 Tm [(disease \(e.g. Crohn)18.1(s and Colitis UK\).)]TJ ET EMC /P <>BDC BT 8 0 0 8 181.4352 345.5203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 328.131 Tm -.125 Tc (16)Tj ET EMC /P <>BDC BT 8 0 0 8 43.7488 328.131 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0863 328.131 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 328.131 Tm (An agreed timeframe for the next appointment should be agreed. )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 316.411 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 316.411 Tm (Reasons for a patient not wanting to attend a clinic appointment )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 304.691 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 304.691 Tm (need to be gently explored.)Tj ET EMC /P <>BDC BT 8 0 0 8 144.7046 304.691 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 36.8504 284.1371 Tm 1 .89 0 0 k (Explanations)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 111.534 284.1371 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 266.4678 Tm (1.)Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 45.9663 266.4678 Tm ( )Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 48.189 266.4678 Tm (The core team should include a nurse, dietitian, pharmacist and )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 254.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 254.4678 Tm [(doctor)55.2(. In most centres, it would be unusual for every patient to be )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 242.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 242.4678 Tm (seen by every team member at every clinic visit. It may also be )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 230.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 230.4678 Tm -.005 Tc (possible and useful for patients to be seen by surgical, psychological)Tj ET EMC /P <>BDC BT 8 0 0 8 288.203 230.4678 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 218.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 218.4678 Tm -.025 Tc [(and stoma care colleagues, if necessary)74.2(. )18.1(There needs to be appropriate)]TJ ET EMC /P <>BDC BT 8 0 0 8 288.2705 218.4678 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 206.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 206.4678 Tm [(space for the NST)18.1( and confidential discussions.)]TJ ET EMC /P <>BDC BT 8 0 0 8 216.5796 206.4678 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 188.7985 Tm -.01 Tc (2.)Tj ET EMC /P <>BDC BT 8 0 0 8 46.0463 188.7985 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 188.7985 Tm -.01 Tc [(A)55.2( preliminary discussion with the NST)18.1( about the current observations,)]TJ ET EMC /P <>BDC BT 8 0 0 8 288.8673 188.7985 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 176.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 176.7985 Tm (blood tests \(done by the HPS centre and/or GP\) and any )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 164.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 164.7985 Tm (communications from other healthcare professions, carers, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 152.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 152.7985 Tm [(relatives or the patient should occur)55.2(. )18.1(This will make it clear which )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 140.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 140.7985 Tm (team members are most important to the visit. Other information )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 128.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 128.7985 Tm (may need to be found such as outcomes from other clinics or other )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 116.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 116.7985 Tm [(hospital attendances. )18.1(The NST)18.1( needs to be aware of new issues )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 104.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 104.7985 Tm (that are of major concern to the patient \(may include new activities, )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 92.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 92.7985 Tm (sports and conception/pregnancy/adoption\).)Tj ET EMC /P <>BDC BT 8 0 0 8 203.8491 92.7985 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 75.1292 Tm (3.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 75.1292 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 75.1292 Tm (Symptoms can be from the underlying disease process or from the )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 63.1292 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 63.1292 Tm [(HPS. )18.1(The latter could include excess nocturnal micturition and )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 51.1292 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 51.1292 Tm [(non-specific ef)18.1(fects of infusions. While it may not be possible to )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 784.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 784.0668 Tm (alter the HPS regime to reduce these symptoms, all prescriptions )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 772.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 772.0668 Tm [(should be looked at critically)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 417.2747 772.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 754.5975 Tm (4.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 754.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 754.5975 Tm [(Hydration/nutritional status is more dif)18.1(ficult to assess at virtual )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 742.7975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 742.7975 Tm (appointments, but the degree of thirst should always be asked. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 730.9975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 730.9975 Tm [(A)55.2( postural drop of blood pressure is an important indicator of )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 719.1975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 719.1975 Tm (chronic dehydration. Renal function and a random urine sodium )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 707.3975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 707.3975 Tm (concentration measurement are helpful, but note that very )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 695.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 695.5975 Tm (underweight patients have a low baseline creatinine. )Tj ET EMC /P <>BDC BT 8 0 0 8 501.0441 695.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 678.1282 Tm (5.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 678.1282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 678.1282 Tm [(Nutritional status, in some centres, is additionally assessed by BIA)55.2( )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 666.3282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 666.3282 Tm (or in some centres computerised tomography \(CT\) at the third )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 654.5282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 654.5282 Tm [(lumbar vertebra \(only if a CT)18.1( scan has been performed for another )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 642.7282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 642.7282 Tm [(reason\). )55.2(An assessment of body composition should be made at )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 630.9282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 630.9282 Tm [(least annually)74.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 366.1418 630.9282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 613.4589 Tm (6.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 613.4589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 613.4589 Tm (Patients should be given plenty of time and space to describe any )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 601.6589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 601.6589 Tm (problems they may be having with the HPS, equipment \(e.g. pump, )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 589.8589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 589.8589 Tm (fridge\) and with their underlying disease. Patients will tend to )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 578.0589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 578.0589 Tm [(describe dif)18.1(ferent problems to dif)18.1(ferent health professionals. )]TJ ET EMC /P <>BDC BT 8 0 0 8 527.4192 578.0589 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 560.5896 Tm (7.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 560.5896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 560.5896 Tm (The entry site of the central venous catheter should always be)Tj ET EMC /P <>BDC BT 8 0 0 8 310.5337 548.7896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 548.7896 Tm [(inspected. )18.1(The integrity and function of the catheter should also )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 536.9896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 536.9896 Tm (be determined. Often at this point swabs for culture and, if deemed )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 525.1896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 525.1896 Tm (appropriate, central and peripheral blood cultures may be taken.)Tj ET EMC /P <>BDC BT 8 0 0 8 540.173 525.1896 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 507.7203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 507.7203 Tm (If patients have unhealed wounds, it may be useful to inspect )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 495.9203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 495.9203 Tm (them, though it is often not appropriate to take down complex )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 484.1203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 484.1203 Tm (dressings and stoma bags in the clinic. Patients can always be )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 472.3203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 472.3203 Tm [(asked to provide photographs and send these to the team. )55.2(An ideal )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 460.5203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 460.5203 Tm (arrangement is for a stoma nurse to be available for the HPS clinic.)Tj ET EMC /P <>BDC BT 8 0 0 8 550.8177 460.5203 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 442.971 Tm (8.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 442.971 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 442.971 Tm [(A)55.2( patient)18.1(s whole illness \(e.g. Crohn)18.1(s disease\) may not be )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 431.091 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 431.091 Tm (reviewed in all HPS clinics and some centres may only review the )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 419.211 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 419.211 Tm (HPS. Diagnoses may change with time \(e.g. possible dysmotility )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 407.331 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 407.331 Tm (to enteric neuropathy\). Consideration is given to the possibility )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 395.451 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 395.451 Tm (of utilising the enteral route and reducing the HPS requirements )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 383.571 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 383.571 Tm [(\(e.g. nights of)18.1(f, or a change to a multi-chamber bag if having a )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 371.691 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 371.691 Tm [(compounded bag\). )18.1(There needs to be separate consideration for )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 359.8109 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 359.8109 Tm (hydration optimisation, and for nutritional optimisation.)Tj ET EMC /P <>BDC BT 8 0 0 8 504.5832 359.8109 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 342.2616 Tm (9.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 342.2616 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 342.2616 Tm (Drugs mainly include anti-diarrhoeal \(loperamide and codeine )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 330.3816 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 330.3816 Tm (phosphate\) and anti-secretory \(omeprazole or pantoprazole\) )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 318.5016 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 318.5016 Tm [(drugs and, increasingly)74.2(, GLP-2 agonists. )18.1(There should be a plan )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 306.6216 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 306.6216 Tm (to reduce/stop opioids and cyclizine \(especially intravenously\). )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 294.7416 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 294.7416 Tm (Drugs taken orally may need to be given in a higher than licensed )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 282.8616 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 282.8616 Tm (dose to be absorbed or consideration given to a topical route. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 270.9816 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 270.9816 Tm (The use of an intravenous proton pump inhibitor \(PPI\) should )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 259.1016 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 259.1016 Tm (be limited to patients who have not responded to an oral PPI.)Tj ET EMC /P <>BDC BT 8 0 0 8 554.0298 259.1016 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 241.5423 Tm -.125 Tc (10.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.3058 241.5423 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 241.5423 Tm -.01 Tc (Renal, liver and bone function tests should be performed regularly as)Tj ET EMC /P <>BDC BT 8 0 0 8 551.992 241.5423 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 229.6523 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 229.6523 Tm [(well as checking magnesium, zinc, selenium, copper)55.2(, haematinics )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 217.7623 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 217.7623 Tm (\(vitamin B12, folate, ferritin/iron studies\), international normalised )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 205.8723 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 205.8723 Tm (ratio \(INR\), and vitamins \(A, D and E are most easily measured\). )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 193.9823 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 193.9823 Tm [(A)55.2( lipid profile is valuable occasionally to ensure that triglycerides )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 182.0923 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 182.0923 Tm (are adequately cleared from the circulation, though most patients )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 170.2023 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 170.2023 Tm [(are not infusing lipid every day)74.2(. C-reactive protein should also be )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 158.3123 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 158.3123 Tm (checked at )Tj ET EMC /P <>BDC BT 8 0 0 8 354.2824 158.3123 Tm -.015 Tc (the same time, as a raised level can be an indicator of )Tj ET EMC /P <>BDC BT 8 0 0 8 311.2657 146.4222 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 146.4222 Tm -.015 Tc (occult infection,)Tj ET EMC /P <>BDC BT 8 0 0 8 366.4691 146.4222 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 368.6917 146.4222 Tm -.005 Tc (but also because a raised level can invalidate certain)Tj ET EMC /P <>BDC BT 8 0 0 8 553.7595 146.4222 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 134.5323 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 134.5323 Tm -.015 Tc [(measurements, such as of the micronutrients. )55.2(A)55.2( baseline bone density)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.3455 134.5323 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1857 122.6423 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 122.6423 Tm -.015 Tc (scan, and also liver ultrasound \(to determine the presence or absence)Tj ET EMC /P <>BDC BT 8 0 0 8 552.7878 122.6423 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 110.7524 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 110.7524 Tm (of gallbladder stones, liver texture and degree of steatosis\) should)Tj ET EMC /P <>BDC BT 8 0 0 8 310.5337 98.8623 Tm ( be arranged at appropriate times. Many HPS centres are now )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 86.9723 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 86.9723 Tm (undertaking regular FibroScans in long-term HPS patients to help )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 75.0823 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 75.0823 Tm [(detect intestinal failure associated liver disease \(IF)55.2(ALD\), although )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 63.1923 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 63.1923 Tm [(its validity in detecting fibrosis in IF)55.2(ALD, has not been conclusively )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 51.3023 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 51.3023 Tm (demonstrated)Tj ET EMC /P <>BDC BT 8 0 0 8 362.2863 51.3023 Tm (.)Tj ET EMC /P <>BDC BT 8 0 0 8 364.389 51.3023 Tm ( )Tj ET EMC Q endstream endobj 128 0 obj <>/XObject<>/ExtGState<>>> endobj 132 0 obj <> endobj 184 0 obj <>stream /Figure <>BDC q 1 i -16 794.836 625.344 -936.03 re 297.645 420.96 m W* n 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS2 gs q 702.114 106.142 -80.977 535.654 11.868 -89.181 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 841.89 595.276 -841.89 re 297.645 420.96 m W n .015015 841.89 595.29 -841.89 re W n /GS1 gs BT /TT4 1 Tf 9 0 0 9 22.6772 814.1656 Tm 1 .15 0 0 k 0 Tc 0 Tw [(THE BRITISH INTESTINAL)18.1( F)55.2(AILURE )37.1(ALLIANCE \(BIF)55.2(A\) T)18.1(O)0(P)18.1( TIPS )37.1(ARTICLE SERIES)]TJ ET EMC /Artifact <>BDC 0 0 0 .6 k .015015 806.781 595.29 1.4171 re f EMC /Artifact <>BDC 1 .1 0 .1 k .015015 0 595.29 31.482 re f EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 22.6772 14.3583 Tm 0 0 0 0 k [(BIF)55.2(A)55.2( is a Specialist Interest Group of ϳԹ )]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 191.2007 14.3583 Tm [(www)37.1(.bapen.org.uk )]TJ ET EMC /Artifact <>BDC 0 0 0 .08 k 36.85 273.983 520.425 275.764 re f EMC /P <>BDC BT 9 0 0 9 56.286 527.4822 Tm 1 .89 0 0 k (Important information)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 149.7797 527.4822 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 56.286 512.6476 Tm (1.)Tj ET EMC /P <>BDC BT /TT6 1 Tf 8 0 0 8 64.79 512.6476 Tm (Blueteq number)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 128.286 512.6476 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 500.6476 Tm [(A)55.2( Blueteq)]TJ ET EMC /P <>BDC BT 4.8 0 0 4.8 99.04 502.9726 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 102.5768 500.6476 Tm [( number must be obtained by a member of the NST)18.1( at the HPS centre before the patient is discharged. )18.1(The Blueteq)]TJ ET EMC /P <>BDC BT 4.8 0 0 4.8 511.4049 502.9726 Tm ()Tj ET EMC /P <>BDC BT 8 0 0 8 514.9417 500.6476 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 488.6476 Tm (number is attached to the HPS centre, so a new number must be obtained if a patient changes HPS centre. Numbers are valid for )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 476.6476 Tm [(12 months, so yearly update is required. )55.2(All HPS patients should be registered on the IF Registry \(formerly known as e-BANS\). )]TJ ET EMC /P <>BDC BT 8 0 0 8 64.79 464.6476 Tm [(The registry needs to be maintained for all patients, including details of any admissions, surgery)74.2(, outpatient clinic outcomes )]TJ 54.5659 0 TD (and any )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 452.6476 Tm (HPS-related complications.)Tj ET EMC /P <>BDC BT 8 0 0 8 161.2743 452.6476 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 56.286 434.9783 Tm (2.)Tj ET EMC /P <>BDC BT /TT6 1 Tf 8 0 0 8 64.79 434.9783 Tm (RAG rating)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 128.286 434.9783 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 422.9783 Tm (Homecare companies \(HCCs\) are vital in supplying HPS to patients. Due to the complexity of this service, there may be occasions)Tj 57.5806 0 TD ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 410.9783 Tm [(during which a HCC)18.1(s capacity may be compromised \(e.g. Covid-19 pandemic, workforce shortages or product shortages\). Clinical )]TJ ET EMC /P <>BDC BT 8 0 0 8 64.79 398.9783 Tm [(teams must have robust contingency regimens in place for every patient, and compounding priority categories must be agreed. )18.1(Thi)]TJ 57.6792 0 TD (s )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 386.9783 Tm (\(RAG rating\) will enable those patients at highest clinical risk to continue to receive compounded HPS \(RED rated\), whilst thos)Tj 55.8042 0 TD (e able )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 374.9783 Tm (to be managed on hybrid, multi-chamber bags or IV fluids and electrolytes are supplied with an alternative regimen \(AMBER or )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 362.9783 Tm (GREEN rated\).)Tj ET EMC /P <>BDC BT /TT4 1 Tf 9 0 0 9 118.5829 362.9783 Tm 1 .89 0 0 k ( )Tj ET EMC /P <>BDC BT 9 0 0 9 56.286 344.309 Tm (Suggested reading)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 164.286 344.309 Tm 0 0 0 .8 k ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 56.286 329.4744 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 64.79 329.4744 Tm [(BIF)55.2(A)55.2( guidelines and recommendations, position statements, and top tips: )]TJ ET EMC /P <>BDC BT 8 0 0 8 324.9423 329.4744 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 317.4744 Tm [(www)55.2(.bapen.org.uk/about-bapen/bapen-special-interest-groups/bifa \(especially on monitoring\))]TJ ET EMC /P <>BDC BT 8 0 0 8 394.3134 317.4744 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 56.286 305.4744 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 64.79 305.4744 Tm -.005 Tc [(Royal College of Physicians \(2023\). Modern outpatient care. Principles and practice for patient-centred outpatient care. )55.2(A)18.1(vaila)]TJ 54.8779 0 TD (ble online:)Tj ET EMC /P <>BDC BT 8 0 0 8 539.8473 305.4744 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 64.79 293.4744 Tm (https://medicalcare.rcp.ac.uk/media/bemfa4cv/cqid_qi_modern-outpatient-care_0.pdf)Tj ET EMC /P <>BDC BT 8 0 0 8 364.9501 293.4744 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 56.286 275.8051 Tm ( )Tj ET EMC /P <>BDC BT 7 0 0 7 483.5544 15.0863 Tm 0 0 0 0 k (October 2023 | Page 3 of 3)Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 782.0668 Tm 0 0 0 .8 k -.1992 Tc (11)Tj ET EMC /P <>BDC BT 8 0 0 8 43.1551 782.0668 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 782.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 782.0668 Tm (Quality of life can be assessed by general questioning, or by formal )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 770.5168 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 770.5168 Tm (questionnaires \(e.g. the Parenteral Nutrition Impact Questionnaire )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 758.9668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 758.9668 Tm (\(PNIQ\)\), which can be sent to the patient in advance of a clinic. )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 747.4167 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 747.4167 Tm (While the outcome of formal assessment will not change the basic )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 735.8668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 735.8668 Tm (nutritional requirement, it can be useful in making balanced )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 724.3168 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 724.3168 Tm [(judgements between what is thought to be required nutritionally)74.2(, )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 712.7668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 712.7668 Tm [(and with what the patient can cope. )55.2(Anxiety and depression may )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 701.2168 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 701.2168 Tm (need a referral to mental health services.)Tj ET EMC /P <>BDC BT 8 0 0 8 193.1538 701.2168 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 683.9976 Tm (1)Tj ET EMC /P <>BDC BT 8 0 0 8 40.2996 683.9976 Tm (2)Tj ET EMC /P <>BDC BT 8 0 0 8 44.3489 683.9976 Tm (.)Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 683.9976 Tm (Establishing current anatomy and planning the timing of surgery )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 672.4475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 672.4475 Tm (\(if required\) will need to be assessed in close liaison with surgical )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 660.8975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 660.8975 Tm (colleagues, often best done separately from the HPS clinic, such )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 649.3475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 649.3475 Tm [(as at a joint medical/surgical MDT)18.1( meeting. )18.1(There will also need to )]TJ ET EMC /P <>BDC BT 8 0 0 8 46.0063 637.7975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 637.7975 Tm -.005 Tc (be close liaison with gastrointestinal radiologists who will use various)Tj ET EMC /P <>BDC BT 8 0 0 8 288.541 637.7975 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 626.2475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 626.2475 Tm [(imaging modalities to assess bowel anatomy)74.2(, quality and length, )]TJ ET EMC /P <>BDC BT 8 0 0 8 45.9663 614.6975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 614.6975 Tm -.005 Tc (and the abdominal wall. For patients referred in from other hospitals,)Tj ET EMC /P <>BDC BT 8 0 0 8 287.2928 614.6975 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 603.1475 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 603.1475 Tm (it will be essential to obtain detailed histories and operation notes )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 591.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 591.5975 Tm (leading up to the first assessment visit. )Tj ET EMC /P <>BDC BT 8 0 0 8 187.8102 591.5975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 36.8504 573.9282 Tm -.125 Tc (13)Tj ET EMC /P <>BDC BT 8 0 0 8 43.7488 573.9282 Tm 0 Tc (.)Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 573.9282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 573.9282 Tm (All HPS centres should have quarterly review meetings with the )Tj ET EMC /P <>BDC BT 8 0 0 8 45.9663 561.9282 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 48.189 561.9282 Tm (homecare companies \(HCCs\) both to flag up generic problems and )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 782.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 782.0668 Tm (those with individual patients. Patients will also have access to the )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 770.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 770.0668 Tm [(MDT)18.1( to flag up problems as soon as they occur)55.2(. )]TJ ET EMC /P <>BDC BT 8 0 0 8 484.8605 770.0668 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 752.4775 Tm -.09 Tc (14.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 752.4775 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 752.4775 Tm (The exact method of data recording will vary from hospital to )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 740.5575 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 740.5575 Tm (hospital, but most will be using computerised medical records. )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 728.6375 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 728.6375 Tm (Many hospitals will have an internal database of patients either )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 716.7175 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 716.7175 Tm (linked to the hospital computerised medical records or managed )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 704.7975 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 704.7975 Tm [(separately within the MDT)110.8(. HPS centres will also need to upload )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 692.8776 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 692.8776 Tm [(data to the IF Registry)74.2(, as required by NHS England. Ideally)74.2(, all )]TJ ET EMC /P <>BDC BT 8 0 0 8 311.1457 680.9576 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 680.9576 Tm (blood results should be held within the hospital computerised )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 669.0376 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 669.0376 Tm (medical record, so that serial measurements can be easily tracked )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 657.1176 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 657.1176 Tm (and plotted.)Tj ET EMC /P <>BDC BT 8 0 0 8 355.1808 657.1176 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 639.4483 Tm -.09 Tc (15.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 639.4483 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 639.4483 Tm [(V)55.2(oluntary patient advocacy groups, for example PINNT)110.8(, can provide)]TJ ET EMC /P <>BDC BT 8 0 0 8 553.0519 639.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 627.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 627.4483 Tm (shared experiences and open routes of communications for new )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 615.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 615.4483 Tm (patients on HPS to talk to others with experience of living with the )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 603.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 603.4483 Tm (treatment, as well as useful practical advice and tips on aspects )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 591.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 591.4483 Tm (such as holidays, travelling, insurance and energy supply/bills.)Tj ET EMC /P <>BDC BT 8 0 0 8 533.9348 591.4483 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 302.0298 573.779 Tm -.09 Tc (16.)Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 573.779 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 573.779 Tm -.005 Tc (Clinic appointments may be missed for good reasons but sometimes)Tj ET EMC /P <>BDC BT 8 0 0 8 553.1457 573.779 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 8 0 0 8 311.1457 561.779 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 313.3683 561.779 Tm (it is due to fear/anxiety and ways to alleviate this are needed.)Tj ET EMC /P <>BDC BT /TT4 1 Tf 6 0 0 6 36.8504 260.1299 Tm (Disclaimer:)Tj ET EMC /P <>BDC BT /TT2 1 Tf 6 0 0 6 69.2 260.1299 Tm ( ϳԹ Position Statements/Guidelines have been prepared as guidance only to assist qualified healthcare professionals in the d)Tj 57.4793 0 TD (ecision-making processes surrounding nutritional)Tj ET EMC /P <>BDC BT 6 0 0 6 544.1434 260.1299 Tm ( )Tj ET EMC /P <>BDC BT 6 0 0 6 36.8504 252.1299 Tm (care. 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