RESUMO
Introduction: Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. .
Introducción: El tratamiento médico nutricional es de gran utilidad en el mantenimiento y recuperación de la salud de los pacientes con desnutrición relacionada con la enfermedad, aunque su implementación puede ser compleja y no está exenta de riesgos. Se entiende por proceso aquel conjunto de actividades que están mutuamente relacionadas o que interactúan para transformar elementos de entrada en resultados. Desde el Grupo de Trabajo de Gestión de la SENPE presentamos el Proceso de Tratamiento Médico Nutricional (PTMN), que tiene por objetivo facilitar la gestión de la nutrición clínica, pensando en un equipo de soporte nutricional multidisciplinar de atención al paciente hospitalizado. En este documento se describen los siete subprocesos que constituyen el PTMN, además de un subproceso previo de cribado nutricional. Cada subproceso se divide en una primera sección con una ficha técnica en la que se detallan sus aspectos generales, mientras que en la segunda sección se proponen objetivos clave, indicadores de calidad y estándares para su evaluación.
Assuntos
Desnutrição , Terapia Nutricional , Humanos , Desnutrição/terapia , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional/métodosRESUMO
El tratamiento médico nutricional es de gran utilidad en el mantenimiento y recuperación de la salud de los pacientes con desnutrición relacionada con la enfermedad, aunque su implementación puede ser compleja y no está exenta de riesgos. Se entiende por proceso aquel conjunto de actividades que están mutuamente relacionadas o que interactúan para transformar elementos de entrada en resultados. Desde el Grupo de Trabajo de Gestión de la SENPE presentamos el Proceso de Tratamiento Médico Nutricional (PTMN), que tiene por objetivo facilitar la gestión de la nutrición clínica, pensando en un equipo de soporte nutricional multidisciplinar de atención al paciente hospitalizado.En este documento se describen los siete subprocesos que constituyen el PTMN, además de un subproceso previo de cribado nutricional. Cada subproceso se divide en una primera sección con una ficha técnica en la que se detallan sus aspectos generales, mientras que en la segunda sección se proponen objetivos clave, indicadores de calidad y estándares para su evaluación. (AU)
Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting.This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. (AU)
Assuntos
Humanos , Desnutrição/terapia , Terapia Nutricional , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional/métodosRESUMO
INTRODUCTION: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. OBJECTIVES: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. METHODS: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. RESULTS: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. CONCLUSIONS: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.
Assuntos
Terapia Nutricional/normas , Terapia Nutricional/tendências , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estudos Transversais , Pesquisas sobre Atenção à Saúde , Unidades Hospitalares/estatística & dados numéricos , Humanos , Equipe de Assistência ao Paciente , EspanhaRESUMO
Introduction: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. Objectives: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. Methods: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. Results: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. Conclusions: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance (AU)
Introducción: el Grupo de Trabajo de Gestión de SENPE tiene entre sus objetivos el conocimiento y desarrollo de herramientas para la evaluación de resultados en salud. Objetivos: obtener un perfil aproximado de los equipos de Nutrición Clínica en los hospitales de España, específicamente sobre su organización, dotación, actividad e indicadores de calidad. Métodos: estudio transversal realizado en 2013 mediante una encuesta estructurada remitida a una muestra aleatoria del 20% de hospitales de la red del Sistema Nacional de Salud, estratificada por número de camas de hospitalización. Resultados: la tasa de respuesta global fue del 67% (83% en centros con más de doscientas camas). En el 65% de los centros, la Nutrición Clínica está a cargo de un equipo coordinado o una unidad, con médico a tiempo completo en solo un 50% de centros. Con frecuencia no se reconocen otros profesionales como parte del equipo o unidad. Existen consultas monográficas especializadas en nutrición clínica en un 62% y se atienden más de 40 nuevas consultas mensuales de hospitalización en el 72% de los centros (más de 80 en el 27%). Entre los centros con equipo de Nutrición se observa una mayor tendencia al seguimiento de indicadores de calidad relacionados con la práctica clínica. Conclusiones: la incorporación de equipos y unidades de Nutrición Clínica es amplia en los hospitales de España. No es frecuente una verdadera organización multidisciplinar y se asumen cargas de trabajo elevadas en relación a las dotaciones de personal. La existencia de estructuras bien organizadas puede acompañarse de beneficios que repercuten directamente en la calidad de la asistencia (AU)
Assuntos
Humanos , Avaliação Nutricional , Dietoterapia/métodos , Dietoterapia/normas , Qualidade dos Alimentos , Desnutrição/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Desnutrição/prevenção & controle , Sociedades Médicas/normasRESUMO
AIM: Antiretroviral treatment implies a high cost to the healthcare system. The aim of this study was to evaluate the clinical and economic impact of efavirenz (EFV) dose adjustment by monitoring plasma concentrations and pharmacogenetic analysis of the 516G>T CYP2B6 polymorphism. MATERIALS & METHODS: One hundred and ninety HIV patients treated with EFV were studied. Plasma EFV concentrations were measured by HPLC with ultraviolet detection, and pharmacogenetic analysis was performed by Real Time (RT)-PCR. RESULTS: One hundred and ninety patients initially treated with a standard dose of EFV (600 mg/day) were studied. In 31 (16.3%) patients, EFV dose was reduced. A total of 87.1% of patients were heterozygous/homozygous carriers (GT/TT). CD4(+) count increased while the minimum steady-state plasma concentration and adverse effects decreased significantly after dose adjustment. Considering only the dose reduction, the adjustments accounted for a saving of 43,539 /year. CONCLUSION: The individualization of EFV dosage guided by genotyping 516G>T CYP2B6 and therapeutic drug monitoring could increase the efficiency of EFV use in antiretroviral treatment.