TY - JOUR
T1 - Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients
T2 - A randomized clinical trial
AU - Mousavi, Maryam
AU - Hayatshahi, Alireza
AU - Sarayani, Amir
AU - Hadjibabaie, Molouk
AU - Javadi, Mohammadreza
AU - Torkamandi, Hassan
AU - Gholami, Kheirollah
AU - Ghavamzadeh, Ardeshir
N1 - Maryam Mousavi Alireza Hayatshahi Amir Sarayani Molouk Hadjibabaie Mohammadreza Javadi Hassan Torkamandi Kheirollah Gholami Ardeshir Ghavamzadeh Parenteral nutrition Clinical pharmacist Bone marrow transplantation Nutrition status Clinical outcome Randomized clinical trial Iran Trial Registration ID: IRCT201203041030N9 An erratum to this article can be found at http://dx.doi.org/10.1007/s00520-013-1987-0 .
PY - 2013/12
Y1 - 2013/12
N2 - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.
AB - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.
KW - Bone marrow transplantation
KW - Clinical outcome
KW - Clinical pharmacist
KW - Iran
KW - Nutrition status
KW - Parenteral nutrition
KW - Randomized clinical trial
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U2 - 10.1007/s00520-013-1920-6
DO - 10.1007/s00520-013-1920-6
M3 - Article
C2 - 23949839
SN - 0941-4355
VL - 21
SP - 3441
EP - 3448
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 12
ER -