Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran,
Support Care Cancer. 2013 Dec;21(12):3441-8. doi: 10.1007/s00520-013-1920-6. Epub 2013 Aug 16.
Parenteral nutrition (PN) is a well-documented supportive care which maintains the nutritional status of patients. Clinical pharmacists are often involved in providing PN services; however, few studies have investigated the effect of a clinical pharmacy-based PN service in resource-limited settings.
We designed a randomized clinical trial to compare the clinical pharmacist-based PN service (intervention group) with the conventional method (control group) for adult patients undergoing hematopoietic stem cell transplantation in Shariati Hospital, Tehran, Iran (2011-2012). In the intervention group, the clinical pharmacists implemented standard guidelines of nutrition support. The conventional method was a routine nutrition support protocol which was pursued for all patients in the bone marrow transplantation wards. Main study outcomes included nutritional status (weight, albumin, total protein, pre-albumin, and nitrogen balance), length of hospital stay, time to engraftment, rate of graft versus host disease, and mortality rate. Patients were followed for 3 months.
Fifty-nine patients were randomly allocated to a study group. The overall intake (oral and parenteral) in the control group was significantly lower than standard daily needed calories (P < 0.01). Patients in the intervention group received fewer days of PN (10.7 ± 4.2 vs. 18.4 ± 5.5 days, P < 0.01). All nutritional outcomes were either preserved or improved in the intervention group while the nutritional status in the control group was deteriorated (P values < 0.01). Length of hospital stay was significantly shorter in the intervention group (P < 0.01). Regarding PN complications, hyperglycemia was observed more frequently in the intervention group (34.5 %, P = 0.01). Two patients in the control group expired due to graft versus host disease at the 3-month follow-up.
A clinical pharmacist-based nutrition support service significantly improved nutritional status and clinical outcomes in comparison with the suboptimal conventional method. Future studies should assess the cost effectiveness of clinical pharmacists' PN services.
肠外营养（PN）是一种有充分文献记录的支持性治疗方法，可维持患者的营养状况。临床药师经常参与提供 PN 服务；然而，很少有研究调查在资源有限的环境中基于临床药师的 PN 服务的效果。
我们设计了一项随机临床试验，以比较在伊朗德黑兰 Shariati 医院接受造血干细胞移植的成年患者中，基于临床药师的 PN 服务（干预组）与常规方法（对照组）的效果（2011-2012 年）。在干预组中，临床药师实施了营养支持的标准指南。常规方法是骨髓移植病房中所有患者遵循的常规营养支持方案。主要研究结果包括营养状况（体重、白蛋白、总蛋白、前白蛋白和氮平衡）、住院时间、植入时间、移植物抗宿主病发生率和死亡率。患者随访 3 个月。
59 名患者被随机分配到研究组。对照组的总体摄入（口服和肠外）明显低于标准每日所需热量（P<0.01）。干预组的患者接受 PN 的天数更少（10.7±4.2 天 vs. 18.4±5.5 天，P<0.01）。干预组的所有营养结果均得到保留或改善，而对照组的营养状况则恶化（P 值均<0.01）。干预组的住院时间明显缩短（P<0.01）。关于 PN 并发症，干预组更频繁地出现高血糖（34.5%，P=0.01）。对照组有 2 名患者在 3 个月随访时因移植物抗宿主病死亡。
与不理想的常规方法相比，基于临床药师的营养支持服务显著改善了营养状况和临床结局。未来的研究应评估临床药师 PN 服务的成本效益。
