RESUMO
UNLABELLED: The prescription and preparation of paediatric parenteral nutrition in Spain are subject to great variability. AIM: To identify how paediatric parenteral nutrition is prescribed and prepared in Spain. MATERIAL AND METHODS: During the first quarter of 2001, a telephone survey was carried out among most of the hospitals in which parenteral nutrition is habitually prepared. The survey included questions on who was in charge of the prescription, the use of different solutions, addition of supplements (carnitine, heparin and glutamine), as well as information on the shelf-life of the mixtures. Subsequently, the results of the survey were compared with the following guidance documents: "Enteral and parenteral nutrition in paediatrics", drafted under the auspices of the Spanish Association for Paediatric Gastroenterology, Hepatology and Nutrition (2000) and the "Guidelines for the use of parenteral and enteral nutrition in adult and paediatric patients"/"Nutrition support practice manual" from the American Society for Parenteral and Enteral Nutrition (1998). RESULTS: Of the 48 hospitals surveyed, paediatric parenteral nutrition was not prepared in 12 of them. the number of food bags prepared daily correlated directly with the size of the hospital. In all cases, the paediatricians were responsible for prescription. In 87% of the centres, this prescription was customized (i.e. solutions adapted to each individual patient). All of the hospitals used dextrose as the source of carbohydrates and specific amino acid solutions for paediatric medicine. Basically, lipid emulsions with long chain triglycerides were used in 65% of cases and another 19% used physical mixtures of MCT and LCT. Only half of the hospitals routinely used all-in-one mixtures. Inorganic phosphate continued to be used in most cases (78%) versus sodium glycerol phosphate. Vitamins and trace elements were added daily in 65% of the hospitals, with alternate administration in the remainder. In half of the centres, heparin was added to the mixture and carnitine in 27%. For 40% of the centres responding to the survey, the solution had to be used within 24 hours of its preparation; 11% did not indicate the shelf-life. CONCLUSIONS: Although parenteral nutrition is prescribed by the paediatricians on all occasions, the preparation protocols differ significantly between hospitals. Standardization is exceptional. It is noteworthy that all-in-one mixtures are only used in half of the hospitals surveyed. We suggest the creation of a multidisciplinary working party (pharmacists, paediatricians, neonatologists) in order to draw up protocols for the preparation of paediatric parenteral nutrition.
Assuntos
Nutrição Parenteral , Criança , Coleta de Dados , Humanos , Preparações FarmacêuticasRESUMO
El objetivo del estudio es analizar la influencia de efavirenz, en dosis única diaria, en la adherencia al tratamiento antirretroviral y las consecuencias clínicas derivadas de la misma. Para ello se realizó un estudio observacional prospectivo en un total de 52 pacientes a los que se incorporó efavirenz como parte del tratamiento antirretroviral activo. Se analizó la adherencia antes y después del cambio de tratamiento, así como la evolución clínica de los pacientes en función de la respuesta virológica. Los resultados muestran que el 65,3 per cent de los pacientes mejoraron su adherencia y un total de 16 pacientes (30,8 per cent) vieron mejorado el cumplimiento por encima del 95 per cent. Esta mejora de la adherencia se tradujo a nivel clínico en un 85,3 per cent de pacientes que presentaron respuesta virológica (completa o parcial). De forma global, se ha pasado de 9 pacientes (17,3 per cent) con una adherencia > 95 per cent a 20 pacientes (38,5 per cent) con una adherencia > 95 per cent. Los resultados señalan la importancia de la dosis única diaria como factor facilitador de la adherencia al tratamiento antirretroviral y por tanto, con capacidad para incrementar la efectividad clínica del mismo (AU)
