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      Safety and quality of parenteral nutrition: Areas for improvement and future perspectives

      review-article
      , RD, LD, CNSC, , BS, PharmD, BCNSP, FMSHP, FASHP, , MD, PhD, , MD, EDIC, FCCM, FASPEN
      American Journal of Health-System Pharmacy: AJHP
      Oxford University Press
      adherence, health-related quality of life, nutritional status, patient-centered care, patient education, parenteral nutrition

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          Abstract

          Purpose

          This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit (held November 8-10, 2021, at Charleston, SC, and Bad Homburg, Germany) and aims to raise awareness concerning unresolved issues associated with the PN process and potential future directions, including a greater emphasis on patients’ perspectives and the role of patient support.

          Summary

          Ensuring that every patient in need receives adequate PN support remains challenging. It is important to have a standardized approach to identify nutritional risk and requirements using validated nutritional screening and assessment tools. Gaps between optimal and actual clinical practices need to be identified and closed, and responsibilities in the nutrition support team clarified. Use of modern technology opens up opportunities to decrease workloads or liberate resources, allowing a more personalized care approach. Patient-centered care has gained in importance and is an emerging topic within clinical nutrition, in part because patients often have different priorities and concerns than healthcare professionals. Regular assessment of health-related quality of life, functional outcomes, and/or overall patient well-being should all be performed for PN patients. This will generate patient-centric data, which should be integrated into care plans. Finally, communication and patient education are prerequisites for patients’ commitment to health and for fostering adherence to PN regimes.

          Conclusion

          Moving closer to optimal nutritional care requires input from healthcare professionals and patients. Patient-centered care and greater emphasis on patient perspectives and priorities within clinical nutrition are essential to help further improve clinical nutrition.

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          Most cited references96

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          EQ-5D: a measure of health status from the EuroQol Group.

          Established in 1987, the EuroQol Group initially comprised a network of international, multilingual and multidisciplinary researchers from seven centres in Finland, the Netherlands, Norway, Sweden and the UK. Nowadays, the Group comprises researchers from Canada, Denmark, Germany, Greece, Japan, New Zealand, Slovenia, Spain, the USA and Zimbabwe. The process of shared development and local experimentation resulted in EQ-5D, a generic measure of health status that provides a simple descriptive profile and a single index value that can be used in the clinical and economic evaluation of health care and in population health surveys. Currently, EQ-5D is being widely used in different countries by clinical researchers in a variety of clinical areas. EQ-5D is also being used by eight out of the first 10 of the top 50 pharmaceutical companies listed in the annual report of Pharma Business (November/December 1999). Furthermore, EQ-5D is one of the handful of measures recommended for use in cost-effectiveness analyses by the Washington Panel on Cost Effectiveness in Health and Medicine. EQ-5D has now been translated into most major languages with the EuroQol Group closely monitoring the process.
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            GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community

            This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.
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              ESPEN guidelines on nutrition in cancer patients

              Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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                Author and article information

                Contributors
                Journal
                Am J Health Syst Pharm
                Am J Health Syst Pharm
                ajhp
                American Journal of Health-System Pharmacy: AJHP
                Oxford University Press (US )
                1079-2082
                1535-2900
                15 June 2024
                13 June 2024
                13 June 2024
                : 81
                : Suppl 3 , Safety and Quality of Parenteral Nutrition: Translating Guidelines Into Clinical Practice Considering Different Organizational Settings
                : S121-S136
                Affiliations
                Option Care Health , Denver, CO, USA
                Clinical Pharmacy Services, Department of Pharmacy, Baptist Medical Center, Jackson, MS, and University of Mississippi School of Pharmacy , Jackson, MS, USA
                Service of Adult Intensive Care, Lausanne University Hospital (CHUV) , Lausanne, Switzerland
                Department of Anesthesiology and Surgery, Duke University School of Medicine , Durham, NC, USA
                Author notes
                Address correspondence to Dr. Wischmeyer ( Paul.Wischmeyer@ 123456Duke.edu ). X (formerly Twitter): @Paul_Wischmeyer
                Article
                zxae077
                10.1093/ajhp/zxae077
                11170503
                38869258
                e810738a-db95-483f-a105-eb3272a6f0d6
                © American Society of Health-System Pharmacists 2024.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 13 June 2024
                Page count
                Pages: 16
                Categories
                Parenteral Nutrition Supplement
                AcademicSubjects/MED00410

                adherence,health-related quality of life,nutritional status,patient-centered care,patient education,parenteral nutrition

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