RESUMEN
One of the important roles of pharmacists as members of a nutrition support team is nutritional prescription support. We developed a nutritional prescription support system (NPSS) that facilitates prescription support and analysis and evaluated its usefulness in nutritional therapy. An NPSS for prescription support and the management of patient information was created. With this NPSS, the nutritional status was assessed, and, on the basis of the results, such variables as the total energy expenditure were calculated. This system allows prescription support for parenteral nutrition (PN) therapy, enteral nutrition (EN) therapy, and the transition period between them. This system was used for 2 representative patients and evaluated. In a malnourished patient receiving oral warfarin, EN solutions were compared by means of the NPSS, and an appropriate EN solution was selected. In addition, the prothrombin time-international normalized ratio was monitored, and favorable results were obtained regarding the adjustment of the warfarin dose and nutritional management. In a patient with aspiration pneumonia, continuous nutritional management to EN from PN therapy was straightforwardly performed with the NPSS. This NPSS allows rapid, comprehensive nutritional management during the transition period to EN from PN therapy, despite these therapies being considered separately in conventional nutritional management. The NPSS is useful for simplifying prescription support and facilitating information sharing among members of a nutrition support team.
Asunto(s)
Nutrición Enteral , Evaluación Nutricional , Nutrición Parenteral Total , Prescripciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Manejo de Atención al Paciente , Grupo de Atención al PacienteRESUMEN
The secondary and adverse effects when biguanides, alpha-glycosidase inhibitor or thiazolidine derivative was used with sulphonylurea agent (SU) as compared with those with SU alone in Type 2 diabetes patients by using Systematic Review. Two-agent concurrent treatment groups, taken from studies in which subjects were assigned to a group given only a sulfonylurea agent and a group given a sulfonylurea agent with the other glycemic control agent (combination of a sulfonylurea agent and a biguanide agent (I), combination of a sulfonylurea agent and an alpha-glucosidase inhibitor (II), and combination of a sulfonylurea agent and thiazolidinedione (III)), were studied in a randomized controlled trial. The secondary efficacy outcome measures were total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, and change in body weight. The incidence of hypoglycemia, feeling of fullness, diarrhea, liver dysfunction, and edema was investigated as a safety outcome measure, and the clinical significance of concurrent treatment with a sulfonylurea agent in addition to the other glycemic control agent was investigated. With respect to (II), an antidiabetic effect was showed. As for (III), it had the disadvantage of increased body weight. Furthermore, increase of HDL-C levels, in particular, was observed. The improving effect of (III) on serum lipids may be clinically effective for considering the pathologic condition of diabetes, which is often complicated by hyperlipidemia.
Asunto(s)
Biguanidas/administración & dosificación , Biguanidas/efectos adversos , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores Enzimáticos/administración & dosificación , Inhibidores Enzimáticos/efectos adversos , Glicósido Hidrolasas/antagonistas & inhibidores , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Lípidos/sangre , Compuestos de Sulfonilurea/administración & dosificación , Compuestos de Sulfonilurea/efectos adversos , Tiazolidinas/administración & dosificación , Tiazolidinas/efectos adversos , Administración Oral , Peso Corporal , Diabetes Mellitus Tipo 2/fisiopatología , Quimioterapia Combinada , Hemoglobina Glucada/análisis , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Since a nutrition support team (NST) began to work in our hospital in March, 2003, we constructed our original nutrition assessment system that supports the prescription formulation of total parenteral nutrition (TPN). However, in daily NST activities, the re-evaluation of this system became necessary because of a high incidence of enteral nutrition (EN) and marked revisions in the dietary reference intakes in Japanese (7th revision). Therefore, we improved this system and added a prescription formulation support function that is also applicable to EN, and also added a function that automatically calculates the necessary doses of nutrients that tend to become deficient in patients with decubituses. This new system allowed the selection/evaluation of EN solutions in a short time with consideration of the 7th revision, and readily identified deficient nutrients and their levels in decubitus patients. We used this system in patients with high-level malnutrition complicated by decubituses and observed certain treatment effects.