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      Calidad de vida de las personas adultas con nutrición parenteral ingresadas en hospitalización domiciliaria: revisión sistemática Translated title: Quality of life of adult people with parenteral nutrition admitted to home hospitalization: systematic review

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          Abstract

          Resumen Objetivo: Revisar la documentación científica relacionada con la calidad de vida de las personas adultas con nutrición parenteral ingresadas en hospitalización domiciliaria. Método: Revisión crítica y sistemática. Los datos se obtuvieron de la consulta a las siguientes bases de datos bibliográficas: MEDLINE (vía PubMed), Cochrane Library, Embase, Scopus y Web of Science. Los términos utilizados, como descriptores y como texto en los campos de registro del título y el resumen, fueron “Home Care Services”, “Parenteral Nutrition” y “Quality of Life”, utilizando los filtros «Humans», «Adult: 19+ years» y «Clinical Trial». Fecha de la búsqueda febrero de 2020. La calidad documental de los artículos se evaluó mediante el cuestionario CONSORT. Resultados: De las 379 referencias recuperadas, tras depurar las repeticiones y aplicar los criterios de inclusión y exclusión, se seleccionaron 7 ensayos clínicos. En 3 (43%) de los ensayos revisados se observó una mejora en relación a la calidad de vida. Las puntuaciones obtenidas mediante el cuestionario CONSORT, oscilaron entre 12,5 y 20,5 sobre una puntuación máxima de 24. Conclusiones: El incremento de la calidad de vida de los enfermos con NPD está directamente relacionado con la del estado y soporte nutricional de los mismos. Se observó una mejor calidad de vida en los pacientes con bomba portátil y en los que se administró teduglutida. El adecuado manejo del catéter y la consecuente disminución de las infecciones también contribuyó a la mejora de la calidad de vida de las personas con NPD.

          Translated abstract

          Abstract Objective: To review the scientific documentation related to the quality of life of adult people with parenteral nutrition admitted to home hospitalization. Method: Critical and systematic review. The data were obtained from the consultation of the following bibliographic databases: MEDLINE (via PubMed), Cochrane Library, Embase, Scopus y Web of Science. Terms used as descriptors and as text in the title and summary record fields were: “Home Care Services”, “Parenteral Nutrition” and “Quality of Life”, using the filters «Humans», «Adult: 19+ years» y «Clinical Trial». Search date February 2020. The documental quality of the articles was evaluated by using the CONSORT questionnaire. Results: From 379 recovered references, after refining the repetitions and applying the inclusion and exclusion criteria, 7 clinical trials were selected. In 3 (43%) of the revised trials it was observed an improvement in relation to the quality of life. The scores obtained by the CONSORT questionnaire were from 12.5 to 20.5 with a maximum score of 24. Conclusions: The parenteral support of patients with home parenteral nutrition (HPN) was directly related to the nutritional status, and it corresponded with an increase in quality of life. An improvement of quality of life was proved in patients that used portable pump and it was likewise proved that the use of teduglutide was beneficial for the quality of life. The correct handle of the catheter and the reduction of infections were also connected with the enhancement of the quality of life of people with HPN.

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          Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome

          Background and aims Teduglutide, a GLP-2 analogue, may restore intestinal structural and functional integrity by promoting repair and growth of the mucosa and reducing gastric emptying and secretion, thereby increasing fluid and nutrient absorption in patients with short bowel syndrome (SBS). This 24-week placebo-controlled study evaluated the ability of teduglutide to reduce parenteral support in patients with SBS with intestinal failure. Methods In 83 patients randomised to receive subcutaneous teduglutide 0.10 mg/kg/day (n=32), 0.05 mg/kg/day (n=35) or placebo (n=16) once daily, parenteral fluids were reduced at 4-week intervals if intestinal fluid absorption (48 h urine volumes) increased ≥10%. Responders were subjects who demonstrated reductions of ≥20% in parenteral volumes from baseline at weeks 20 and 24. The primary efficacy end point, a graded response score (GRS), took into account higher levels and earlier onset of response, leading to longer duration of response. The intensity of the response was defined as a reduction from baseline in parenteral volume (from 20% to 100%), and the duration of the response was considered the response at weeks 16, 20 and 24. The results were tested according to a step-down procedure starting with the 0.10 mg/kg/day dose. Results Using the GRS criteria, teduglutide in a dose of 0.10 mg/kg/day did not have a statistically significant effect compared with placebo (8/32 vs 1/16, p=0.16), while teduglutide in a dose of 0.05 mg/kg/day had a significant effect (16/35, p=0.007). Since parenteral volume reductions were equal (353±475 and 354±334 ml/day), the trend towards higher baseline parenteral volume (1816±1008 vs 1374±639 ml/day, p=0.11) in the 0.10 mg/kg/day group compared with the 0.05 mg/kg/day group may have accounted for this discrepancy. Three teduglutide-treated patients were completely weaned off parenteral support. Serious adverse events were distributed similarly between active treatment groups and placebo. Villus height, plasma citrulline concentration and lean body mass were significantly increased with teduglutide compared with placebo. Conclusions Teduglutide was safe, well tolerated, intestinotrophic and suggested pro-absorptive effects facilitating reductions in parenteral support in patients with SBS with intestinal failure. ClinicalTrials.gov number NCT00172185.
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            Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial.

            Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.
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              Quality of life in patients with short bowel syndrome treated with the new glucagon-like peptide-2 analogue teduglutide--analyses from a randomised, placebo-controlled study.

              Short bowel syndrome (SBS)-intestinal failure (IF) patients have impaired quality of life (QoL) and suffer from the burden of malabsorption and parenteral support (PS). A phase III study demonstrated that treatment with teduglutide, a glucagon-like peptide 2 analogue, reduces PS volumes by 32% while maintaining oral fluid intake constant; placebo-treated patients had reduced PS by 21%, but oral fluid intake increased accordingly. As effects of teduglutide on QoL are unknown, they were investigated here. QoL analyses from a double-blind, randomised Phase III study in 86 SBS-IF patients receiving teduglutide (0.05 mg/kg/day s.c.) or placebo over 24 weeks. At baseline and every 4 weeks, QoL was assessed using the validated SBS-QoL™ scale. PS reductions were associated with QoL improvements (ANCOVA, p = 0.0194, SBS-QoL per-protocol). Compared to baseline, teduglutide significantly improved the SBS-QoL™ total score and the score of 9 of 17 items at week 24. These changes were not significant compared to placebo. Teduglutide-treated patients with remaining small intestine >100 cm experienced more gastrointestinal adverse events (GI-AE), unfavourably affecting QoL. Overall, PS volume reductions were associated with improvements in SBS-QoL™ scores. The short observation period, imbalances in oral fluid intake in relation to PS reductions, large patient and effect heterogeneity and occurrence of GI-AE in a subgroup of teduglutide-treated patients may account for the inability to show statistically significant effects of teduglutide on SBS-QoL™ scores compared to placebo. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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                Author and article information

                Journal
                had
                Hospital a Domicilio
                Hosp. domic.
                Centro Internacional Virtual de Investigación en Nutrición (CIVIN) (Alicante, Alicante, Spain )
                2530-5115
                September 2020
                : 4
                : 3
                : 117-131
                Affiliations
                [2] orgnameInstituto de salud Carlos III orgdiv1Escuela nacional de medicina del Trabajo España
                [3] Valencia orgnameUniversidad Miguel Hernández de Elche orgdiv1Departamento de Salud Pública e Historia de la Ciencia Spain
                [4] orgnameInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO) España
                [5] orgnameHospital General Universitario de Alicante orgdiv1Unidad de Hospitalización a Domicilio España
                [1] Valencia orgnameUniversidad Miguel Hernández de Elche orgdiv1Facultad de Farmacia Spain
                Article
                S2530-51152020000300117 S2530-5115(20)00400300117
                10.22585/hospdomic.v4i3.109
                25c14668-3766-4cfa-b295-014c44de22b3

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 03 June 2020
                : 01 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 15
                Product

                SciELO Spain

                Categories
                Artículos de revisión

                Servicios de Atención de Salud a Domicilio,Quality of Life,Parenteral Nutrition,Apoyo Nutricional,Calidad de Vida,Nutrición Parenteral,Nutritional Support,Home Care Services

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