1. Training Materi Enteral Utk New MR

3. Nutritional Assessent Functional GI Tract Yes No Enteral Nutrition Parenteral Nutrition GI Function Short Term Long Term or Fluid Restriction GI Function Returns Long Tern Gastrostomy Jejunostomy Short Term Nasogastric Nasoduodenal Nasojejunal INDIKASI NUTRISI ENTERAL DAN PARENTERAL Normal Standard Nutrients Compromised Speciality Formula Adequate Proceed To Oral Feedings Adequate Progress to More Complex Diet and Oral Feedings as Tolerated Progress to Enteral Feedings Yes No Nutrients Tolerance Peripheral PN Central PN Inadequate PN Supplementation Guidelines for the Use of Parenteral and Enteral Nutrition in Adults and Pediatric Patients. ASPEN Board of Directors & Clinical Guidelines Task Force, JPEN, 26 (1) Suppl, 2002.

4. Nutrisi enteral merupakan metoda pemenuhan zat gizi dengan menggunakan saluran pencernaan, baik secara alami melalui mulut ataupun dengan bantuan alat / tube feeding / Pipa Lambung WHEN THE GUT WORKS, USE IT ! Nutrisi Enteral :

6. Casein + Arginin + Glutamin (12.5 gr/sachet) Casein (6 gr/saset) Soya Protein (10 gr/sachet) Protein MCT Fish Oil Corn Oil (5.79 g/saset) MCT Soya Oil (10.28 g/saset) Soya Oil (5.8 g/saset) Lemak Vitamin + Mineral Vitamin + Mineral Vitamin + Mineral Mikro Nutrien Fruktosa + Maltodekstrin + Fiber (25.01 g/saset) Sukrosa + Maltodekstrin (21.81 g/saset) Sukrosa + Maltodekstrin + Fiber (27.7 g/saset) KH 48 gr/200 kal 1 kal/ml 40 gr/200 kal 1 kal/ml 52 gr/200 kal 1 kal/ml Kemasan Spesial Polimerik Polimerik Kelompok Neomune Pan Enteral Proten

7. PROTEN ® Vitamin: Vit A, B1, B12, C, D, dan E Mineral: Ca, P, I, Mg, Cu, Zn, Cl, K, Na, Mn, Fe 25% LEMAK (Soy bean oil) Anjuran Pemakaian: 1 – 4 saset / hari; dapat diberikan untuk pasien dewasa (infeksi, jantung, TB, malnutrisi) & anak (alergi susu sapi); bebas laktosa Cara Penyiapan: Tuangkan 1 saset Proten dan larutkan dalam 200 – 300 ml air; Diberikan per oral. 55% KARBOHIDRAT (Maltodextrin & Sukrosa) 20% PROTEIN (Soya Protein) % DARI TOTAL KALORI DISTRIBUSI KALORI

8. PAN ENTERAL ® Vitamin: Vit A, D, E, K, B1, B2, B6, B12, C, As Pantotenat, Niasin, As Folat, Biotin, Choline, Inositol Mineral: Ca, P, I, Fe, Mg, Cu, Mn, Zn, Cl, K, Na Cara penyiapan: Tuangkan 1 saset Pan Enteral dan larutkan dalam 200 – 300 ml air Dapat diberikan per oral atau dengan NGT (Fr 8) 44% LEMAK  MCT : LCT = 48 : 52 Anjuran Pemakaian: 1 – 4 saset / hari; dapat diberikan untuk pasien dewasa & anak (bebas laktosa) Pan Enteral baik untuk kasus-kasus dengan gangguan absorpsi Lemak; gangguan respirasi; stroke; pasca operasi, kondisi-kondisi dimana asupan oral tidak dimungkinkan atau tidak mencukupi . 44% KARBOHIDRAT  Dextrin : Sukrosa = 50 : 50 12% PROTEIN (Casein) % DARI TOTAL KALORI DISTRIBUSI KALORI

9. Positioning Statement PAN ENTERAL : Nutrisi Enteral Lengkap dan Seimbang, Kaya MCT dan Osmolaritas Rendah untuk memenuhi kebutuhan nutrisi pasien. PROTEN : Asupan Protein Harian untuk mengatasi Kurang Energi Protein (KEP) dan mempercepat penyembuhan. Target Pasien : PAN ENTERAL : Bayi, Anak, Dewasa dan Manula. · PROTEN : Anak, Dewasa, dan Manula Core Product Strategy PROTEN & PAN-ENTERAL

10. Core Product Strategy Proten

12. THE ROLE of FIELD FORCE DETAILING DELIVERING COLLECTING Medis ( Dokter ) Para medis ( Ahli Gizi ) Logistik Keuangan Pembelian MEDICAL REPRESENTATIVE . SALESMAN Taking / Repeat order Stock Monitoring MEDICAL FOODS REPRESENTATIVE PT-OI MUP

16. Proten FAB

17. Competitor Analysis

18. Core Product Strategy Pan -Enteral

20. Pan Enteral

25. Flowchart Aktivitas Ilmiah

28. Target Rumah Sakit Berdasar Fungsi Nutrisi Enteral

29. Sales Achievement Pan Enteral growth (box) - % Proten growth (box) - %

31. Contoh Menu Harian RS

32. Menu Harian Penukar Makanan

33. Menu Harian dgn Proten

35. 8. Core Product Strategy Target & Key Message PROTEN & PAN ENTERAL

36. PROTEN ® Core Product Strategy

37. PROTEN ® Core Product Strategy

39. PAN-ENTERAL ® Core Product Strategy

40. PAN-ENTERAL ® Core Product Strategy

41. Brosur PAN ENTERAL-PROTEN

42. Iklan Proten

43. Nutrisi & Imunitas Muscle Wasting Deplesi Sistem Imunitas Dukungan Nutrisi Artifisial Energi Protein Mikronutrien Esensial

44. Perjalanan infeksi

46. Modulasi respon radang oleh Imunonutrisi

51. Asam Lemak Tak Jenuh Ganda Linoleic acid (18:2 w6)  -Linolenic acid (13:3 W3) Arachidonic acid(20:4 w6) PG2 Series LT4 Series PG3 Series LT5 Series PG1 Series  -6 Fatty Acid  -3 Fatty Acids dihomo-γ-linoleic acid (20:3 w6) Docosahexaenoic acid (22:6 w3) (DHA) Eicosapentaenoic acid (20:5 w3) (EPA)

52. Meta-analisis: Immunonutrition Enteral Diet Beale, RJ et al. Immunonutrition in the critically ill: A Systematic review Of clinical outcome. Crit Care Med 1999 Vol 27, No 12. 12 uji klinis: 1482 pasien p < 0.05 = berbeda bermakna 0.04 Perlakuan vs Kontrol - 2.6 hari Lama Pemakaian Ventilator 0.0002 Perlakuan vs Kontrol - 2.9 hari Lama Perawatan di RS 0.005 Perlakuan vs Kontrol 0.60 Angka Kejadian Infeksi p Efek Perlakuan (CI 95%)

53. Meta-analisis:Immunonutrition Enteral Diet pada Pasien Bedah Digestif 6 uji klinis: 497 pasien; * = Berbeda Bermakna Infeksi yang dinilai: pneumonia, abses intra abdomen, infeksi luka, bakteriemia Heys S D et al. Enteral Nutrition Supplementation with Key Nutrients in Patients With Critical Illness and Cancer: Ann Surg Vol 229, No. 4, 467 – 477, 1999. - 2.4 hari * Lama Perawatan di RS 61/244 (25%) 32/243 (13%)* Angka Kejadian Infeksi 4/251 (2%) 6/246 (2%) Angka Mortalitas Kontrol Immunonutrition

55. Immunonutrisi dan Trauma p < 0.001 p < 0.05 SIRS  MOF  Weinmann, 1998 Trauma (n = 32) p = 0.02 p = 0.02 p = 0.03 Komplikasi infeksi  Pemakaian antibiotik  Lama Perawatan  Kudsk, 1996 Trauma (n = 35) p = 0.023 p = 0.023 Abses intraabdomen  MOF  Moore, 1994 Trauma (n = 98) Hasil (IMN vs SD) Uji Klinis

56. Immunonutrisi dan Luka Bakar Gottschlich M M, et al. Differential Effects of Three Enteral Dietary Regimen on Selected Outcome Variables in Burn Patients. JPEN 1990, Vol. 14, 3, 225-236 NS 0.03 0.06 0.07 NS NS NS 0.02 19 4 8 9 21 5.8 14 4.7 1.21 17 3 2 2 7 4.7 9 3.8 0.83 14 2 8 6 16 7.6 10 5.0 1.21 Jumlah Bakteriemia Infeksi luka Pneumonia Total Infeksi Antibiotik (hari) Ventilator (hari) Jumlah operasi Lama rawat inap/% LLB p < Grup 3 TRM Grup 2 IMN Grup 1 OSM

57. Pengaruh Pemberian IMN pada Pasien Sepsis di ICU n = 181; infeksi nosokomial: Infeksi saluran kemih, pneumonia, trakheobronkitis, infeksi kateter. Galban C, et al. An immune-enhance enteral diet reduces mortality rate and Episodes of bacteremia in septic ICU patients. Crit care Med 2000, vol 28, no. 3. p = 0.01 20% 6% Infeksi nosokomial > 1 p = 0.01 22% 8% Bakteriemia p = 0.02 28% 4% Mortalitas (APACHE II = 10 – 15) p = 0.05 32% 19% Mortalitas p Kontrol IMN

58. Dosis Pemberian IMN pada Pasien Critically-ill dan Sepsis 19 ml/kg BB/hari Sepsis Galban et al, Crit Care Med 2000; 28: 643 17 ml/kg BB/hari Critically - ill Atkinson et al, Crit Care Med 1998; 26:1164 18 ml/kg BB/hari Sepsis Bower et al Crit Care Med 1995; 23:436 Asupan rata-rata Kelompok

59. ( + ) Polydextrose ( - ) FIber + + + + + + Beta Carotene; Carnitin; Taurine 400 493 Osmolarity (mOsm/Kg H2O) 1.0 1.5 Cal/ml MCT; Fish Oil; Corn Oil (28 g/L) Canola Oil; MCT; Fish Oil; Borage Oil; Lecithin (93.7 g/L) Sumber Lemak Fructose; Maltodextrin (125 gr/L) Sucrose; Maltodextrin (105.5 g/L) Sumber Karbohidrat Casein; L-Glutamin L-Arginin (62.5 g/L) Casein ; (62.5 gr/L) Sumber Protein Neomune Oxepa

65. Feature & Benefit L - Glutamine

66. Feature & Benefit  3 - PUFA

67. Neomune  Immune-enhancing Formula

68. Neomune  125 52.1 50 Karbohidrat Dextrin 90% Fruktosa 10% 10 4 Serat Polydextrose 28 12.1 25 Lemak MCT 50% Corn Oil 30% Fish Oil 20% 62.5 26.1 25 Protein Kasein 70% Arginin 20% Glutamin 10% g/1000 kal % W/W % Kalori Sumber