[Economic assessment of the implementation of a parenteral nutrition protocol for patients undergoing intestinal resection by a multidisciplinary team]. / Evaluación económica de la implantación por un equipo multidisciplinar de un protocolo de nutrición parenteral en pacientes tras resección intestinal.

OBJECTIVE: An economic assessment on the impact of total parenteral nutrition guidelines developed by the Hospital Nutrition Committee for patients undergoing intestinal resection and implemented by a nutritional support multidisciplinary team, was conducted. METHOD: A comparative retrospective study of two consecutive annual periods before and after the implementation of total parenteral nutrition guidelines for patients undergoing intestinal resection developed by the Nutrition Committee was carried out. Cost-effectiveness analysis from the hospital perspective was performed with the pharmacoeconomic program Pharma-Decision Hospital. Effectiveness was assessed as nutritional gain and safety profile; as well as determination of the costs of acquisition, preparation, administration, monitoring and nutritional complications. Sensitivity analysis (+/-20%) of effectiveness and hospital stay. RESULTS: Among 326 patients hospitalized for intestinal resection, 69 out of 172 (40%) received parenteral nutrition during the early period, versus 40 out of 154 (26%) after the surgery procedure (p < 0.01). In 79% of the patients with parenteral nutrition, the adequacy of the indication was assessed, being adequate in 51.7% and 56.7%, respectively (p = 0.66). Nutritional gain before and after surgery was similar (78.3 vs. 82.5%, p > 0.05), with patients having less episodes of hypophosphatemia postoperatively (60 vs. 38%). Mean total cost per patient before and after surgery was 9,180.81 and 7,871.96, respectively. The sensitivity analysis confirmed the above results. CONCLUSIONS: The development of total parenteral nutrition guidelines by the Nutrition Committee for surgical patients undergoing intestinal resection and their implementation by a multidisciplinary team improved the use of parenteral nutrition and reduced associated costs, with the same nutritional evolution.

[Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition]. / Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total.

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p < 0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs. 40.49%; p < 0.02), TPN ending for clinical improve- ment (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 +/- 20.43 vs. 11.88 +/- 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course.

[Oral or sublingual nifedipine: utility and long-term effectiveness of medical education to decrease its use in increased blood pressure]. / Nifedipino oral o sublingual: utilidad y efectividad a largo plazo de la educación médica para disminuir su uso en la hipertensión.

OBJECTIVES: Despite the severe side effects reported, short acting nifedipine compounds (oral or sublingual) are still widely used for the considered hypertensive emergencies. The objective of this study was to study the effect of simple medical education measures on the prescription of such compounds in our institution. METHODS: In a previous survey we found that 67% of physicians involved in the care of hypertensive emergencies at our institution considered oral/sublingual nifedipine the therapy of choice. The recommendations in the JNC VI document were reviewed in a Clinical Session and each participating physician was provided with a translated copy and a letter with the reasoned answer. The Pharmacy Department provided a list of patients with the prescriptions of nifedipine upon request and programmed in the Emergency Department, Medical and Surgical Departments. Four time periods were considered: first or control (pre-session): September 1997-March 1998; second (immediately post-session): June 1998-December 1998; third (9-12 months post-session): January 1999-June 1999, and fourth (28-34 months post-session): September 2000-March 2001. At a later session the results were presented and a summary of results was submitted to Departments with a consensus note on the prescription of short acting nifedipine compounds. RESULTS: There were significative decrements in urgent and total doses and treated patients during the periods considered. This effect was sustained and in a three-year period reductions of 78% (Emergency Room), 91% (Medical Services) and 79% (Surgical Services) of prescriptions were noted. CONCLUSIONS: Simple measures of continuous medical education (scientific meetings, personal letters and facilitated access to scientific evidence) were highly effective in reducing prescriptions of short-acting nifedipine at our centre.