The role of muscle targeted interventions in aging and disease (Emanuele Cereda)

Sarcopenia has been recently recognized as a muscle disease, with significant adverse consequences on health. Recommended treatment is based on individually tailored resistance exercise training program, optimization of protein intake using high-quality protein sources (i.e. whey proteins providing high amounts of essential amino acids such as leucine) and addressing vitamin D deficiency/insufficiency.

Muscle-targeted oral nutritional supplementation (MT-ONS has been extensively tested in clinical trials, mostly using high-quality randomized controlled trial design and demonstrating efficacy in increasing muscle mass and strength as well as physical performance versus iso-caloric placebo or standard practice in older patients with sarcopenia. Consistent results have been observed in various clinical settings (community, rehabilitation centers, care homes), with or without adjunctive physical exercise programs. Furthermore, a positive effect on markers of inflammation have been shown. A muscle protein-sparing effect, with benefits on physical performance and function, has been also demonstrated in patients at risk of losing skeletal muscle mass, such as patients undergoing weight loss programs or intensive rehabilitation programs associated with neurological disability (Parkinson’s disease). Most recently, MT-ONS has demonstrated not only a significant efficacy on clinical variables, but also a positive impact on healthcare resource consumption in the rehabilitation setting (length of stay and duration of rehabilitation programs).

In summary, MT-ONS, alone or in association with an appropriate exercise program, is an effective therapy for older patients with sarcopenia and should be offered as a first-line treatment, not only to improve clinical outcomes but also to reduce healthcare resource consumption, in particular when patients are admitted to a rehabilitation center.

A dedicated IBS Care-pathway and its impact on endoscopy waiting lists, healthcare costs and patient outcomes (Eilish Joyce)

Irritable Bowel Syndrome (IBS) is a chronic debilitating condition affecting 5-11% of the population, placing a significant burden on health services. Patients with possible IBS commonly undergo extensive endoscopic investigations. Clinical guidelines recommend that a positive diagnosis of IBS is based on presenting symptoms and non-invasive blood and stool tests in patients who satisfy a diagnosis of IBS using Rome IV criteria . Further endoscopic or radiological assessments are not recommended once a diagnosis of IBS has been established.

Following a successful pilot in 2018/2019, an effective evidence-based interdisciplinary IBS care pathway has been rolled out in St James’s Hospital.

Between Sept 2018 and May 2019, all referrals received for endoscopy were triaged by the gastroenterology medical teams. Patients who met specific criteria were diagnosed with IBS and referred for individualised dietetic intervention, following an agreed pathway, and outcomes assessed.

87% of those who completed dietary intervention were discharged without endoscopy , saving up to 153 endoscopy slots and €103,953 (HSE ABF guide, 2019)

Functional gastrointestinal disorders account for approx. 40% of referrals to our gastroenterology service, of which IBS is the most common diagnosis. NICE guidelines for management of IBS centre on dietary education and intervention strategies provided by qualified dietitians

This pilot of an interdisciplinary IBS care pathway demonstrated symptom resolution and improved patient care, reducing unnecessary investigations. This allowed consultant gastroenterologists to re-allocate endoscopy slots and resources, potentially reducing delays in diagnosis of malignant and other organic conditions.

New approaches to optimising outcomes of COVID patients post-discharge (Dr Peter Collins)

The COVID-19 global pandemic has resulted in an unprecented demand on health care systems around the world, from intensive care beds and specialist equipment, through to the ability to support patients during their recovery in the community. Whilst much of the focus has been on the life-threatening impact of the disease and the need for specialist life-preserving critical care, the broader impacts of the disease in terms of malnutrition, fraility and prolonged impaired physcial function, are only now starting to be realised ('Long COVID'). Almost a quarter of a million people in Ireland have contracted COVID-19 since the outbreak against a backdrop of approximately 15,000 available beds across Irish hospitals. This pressure on hospital beds means coordinated nutritional care from hospital to home is essential. In addition, early comprehensive nutritional screening and assessment linked to evidence-based nutrition care plans across all points of the health care continuum, and involving all members of multidisciplinary teams, is of crucial importance to prevent nutritional decline and enhance recovery.