BackgroundTotal Parenteral Nutrition (TPN) isn’t always prescribed according to international guidelines: nutritional screening is frequently lacking, the prescribed therapy is not always adapted accordingly and subsequent monitoring is often absent. Our objective was to assess the potential benefit of a clinical pharmacist reviewing prescribed TPN.PurposeEvaluation of the appropriateness of prescribed TPN.Material and methodsSetting: A prospective pre-post intervention study in a tertiary care teaching hospital with a high percentage of cancer and critically ill patients.Method: Adult hospitalised patients on TPN were included. The presence of a Nutritional Risk Screening-2002 and the calculation of energy requirements, the indication, the therapy appropriateness and the therapy duration were assessed by a clinical pharmacist. During the intervention period feedback was provided to the physician and dietician in multidisciplinary collaboration. The ESPEN guidelines were taken as golden standard. All data were obtained from the electronic patients files.ResultsWe assessed 272 hospitalisations, 152 pre-interventional (10/2013–01/2014) and 120 post-interventional (02/2014–04/2014). During the latter period an intervention was needed in 83.7% (176 interventions) of the cases. Prevalence of nutritional screening increased from 25.0% to 61.7% (p < 0.001) as did energy requirement calculation (30.9% vs. 67.5%; p < 0.001). Therapy appropriateness increased from 58.8% to 75.8% (p < 0.05). The median duration (6.0 vs. 7.0 days) of the therapy was not significantly reduced (p = 0.36). We avoided the production of at least 81 TPNs on a total of 1172. During the 3 month intervention period an estimated total saving of 20756€ could be obtained.ConclusionThe additional monitoring of the appropriateness of TPN by a clinical pharmacist has a positive influence on therapy quality and healthcare costs.References and/or acknowledgementsESPEN guidelines ()Nutrition support teamNo conflict of interest.
To assess clinical efficacy and cost-effectiveness of human recombinant interferon-␣2b in neonates with intrauterine infections in neonatal intensive care unit (NICU). METHODS: We observed 151 neonates (gestational age (GA) 25-40 weeks) with severe intrauterine infections in NICU. Group 1 included 94 neonates with severe intrauterine infections treated with interferon-␣2b, 150 000 IU per suppositorium twice a day per rectum during 7 days in addition to combined antibacterial and supportive therapy; group 2 consisted of 57 neonates under standard treatment without additional immunotherapy. Initially neonates of both groups were comparable. Effectiveness data were used to populate a decision model to estimate the cost-effectiveness of interferon-␣2b and standard therapy. Direct and indirect costs were measured. Published cost data were applied to assess differences in treatment costs. RESULTS: Low mitogen-induced interferon-␣ production (Ͻ12 pg/ml) was detected in 25% [18%; 33%] of neonates with severe intrauterine infections, its association with significantly higher incidence of pneumonia ( Ͻ0.001), necrotizing enterocolitis ( Ͻ0.001) and urinary tract infections ( ϭ0.026) was proved. Administration of human recombinant interferon-␣2b to neonates, suffering from severe infections, provides improvement of mitogen-induced production of interferon-␣, reduces hospital length of stay and mortality rates ( ϭ0.009, OR ϭ 0.
0.62 (0.64) mg/dL, AGP 85.21 (22.00) mg/dL and FC 174.75 (220.25) mg/g. Clinical status after the intervention was GGC 43 (78.18%), RGC 11 (20%) and BGC 1 (1.82%). Conclusion and relevance After the intervention, patients showed a tendency to decreased inflammatory parameters and clinical improvement, with a subjective reduction in symptoms. TDM in association with recommendations of the pharmacy service are valuable strategies in optimising IBD treatment to avoid loss of response and achieve better clinical outcomes.
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