the practice of parenteral nutrition in malaysian hospitals riyadh abdullah omar albatani universiti

45 Pages·2009·0.14 MB·English

THE PRACTICE OF PARENTERAL NUTRITION
IN MALAYSIAN HOSPITALS

RIYADH ABDULLAH OMAR ALBATANI

UNIVERSITI SAINS MALAYSIA
2008
THE PRACTICE OF PARENTERAL NUTRITION IN MALAYSIAN
HOSPITALS

by

RIYADH ABDULLAH OMAR ALBATANI

Thesis submitted in fulfillment of the requirements
for the degree of
Doctor of Philosophy

June 2008
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ACKNOWLEDGEMENTS
I am extremely grateful to Dr.Mohd Baidi Bahari (School of pharmaceutical Sciences,
Universiti Sains Malaysia) for introducing me to scientific research and helping me
establish my overall direction. His advice and constructive criticism have been
invaluable in the fruition of this doctoral thesis for maintaining my focus and for his
insight guidance in picking up key findings that I may have overlooked. For his kinds of
introducing me to the “hands-on” practical work of clinical research and for his help in
conducting the studies which formed part of this doctoral thesis, I am thankful to his
constant encouragement and support, his warm presence and for consistently reminding
me to “Keep smiling”. I am also thankful to Pn. Zalila Ali (USM Mathmatic School) for
introducing me to new approaches in analysing data, also thanks to Dr.A.F
Shammsuddin (Field-supervisor, HUKM Pharmacy Department), Mr. Amrahi Buang
(UMMC) and Mr. Dellimin Che Abdullah (HUSM). Thanks to Dr. Mohd Izham Mohd
Ibrahim (USM Social and Administrative Pharmacy) for assisting me in statistics. I am
especially appreciative of the Yemen Government and specifically University of Sana’a
for granting me this opportunity to gain experience in a foreign country and to broaden
my horizons. I have been fortunate to have a large number of friends and colleagues who
have had a profound effect on me and on my research. Last, but not least, I would like
to dedicate this thesis to my family, especially to my parents for providing me with the
essential tools, during my formative years, to pursue and realise my dreams, my brothers
Fatima, Sefan and Mohd and my wife Amina for her support and endless patience when
I most needed it. They will always remain the guiding light in my life as I look forward
to new challenges in the near future.
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TABLE OF CONTENTS
Acknowledgements ii

Table of contents iii

List of tables xi

List of abbrevations xiv

Abstrak xvi

Abstract xviii

Part 1 Survey of TPN practice in Malaysian hospital 1

1.1 Introduction and literature review 1

1.1.1 Background 1

1.1.2 Practices of PN 3

1.1.3 Problem statement 8

1.1.4 Rationale of the study 10

1.1.5 Objectives 11

1.1.6 Justification of the study 12

1.2 Methodology 13

1.2.1 Introduction 13

1.2.2 Parenteral nutrition practice in Malaysian hospitals 13

1.2.3 Study design of survey of evaluation of PN Practice in 14

Malaysian hospital

1.2.4 Determination the sample size 14

1.2.5 Subjects (hospitals) 16
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1.2.5 (a) Selection of hospitals 16

1.2.5 (b) Inclusion criteria 17

1.2.5 (c) Exclusion criteria 17

1.2.6 Data Analysis 17

1.3 Results and discussion 19

1.3.1 Response rate 19

1.3.2 Classification of hospitals 20

1.3.3 PN services in Malaysian hospital 21

1.3.4 Hospital size 22

1.3.5 Availability of PN services 23

1.3.5 (a) PN services and mean of pharmacist and 23

pharmacist assistant

1.3.5 (b) Mean of preparation per day 24

1.3.6 Type of specialties 25

1.3.7 Type of Clinical Pharmacy services offered 26

1.3.8 Clinical services offered pharmacy department 27

according to type of hospitals.

1.3.9 Year started parenteral nutrition services 28

1.3.10 Ward with PN services 29

1.3.11 Places for preparation of PN 30

1.3.12 Type of services related to PN 31

1.3.12 (a) Individualization 32

1.3.12 (b) Standard formulas 33

1.3.12 (c) Computer program 33
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1.3.13 Extent of pharmacist involved in PN 34

1.3.13 (a) PN pharmacist compounding 34
1.3.13 (b) PN monitoring and nutrition support team 35

1.3.14 Quality control of PN compounding 36

1.3.15 The use of commercially available standard product 39

1.3.16 Suggestions of services offered by PN 40

pharmacists

1.3.17 Type of solution used in PN 41

1.4 Summary and conclusion 43

1.4.1 PN Practices in Malaysian Hospital 43

1.4.2 The extend of the PN services 43

1.4.3 The personnel involve in PN services 43

1.4.4 The load of pharmacist 44

1.4.5 The role of pharmacist 44

Part 2 Compare service provided in four hospitals 45

2.1 Introduction and literature review 45

2.1.1 Indication 45

2.1.1.1 Parenteral nutrition in malnutrition 46

2.1.1.2 (a) Parenteral nutrition in premature 47

2.1.1.2 (b) Special considerations in premature nutritional 47

supplement

2.1.1.3 Parenteral nutrition in children 48

2.1.1.4 Parenteral nutrition in surgical case 49

2.1.1.5 Parenteral nutrition in cancer 49
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2.1.2 Nutrient and substrate requirments for PN 50

2.1.2. (a ) Protien 51
2.1.2 (b) Carbohydrate 53
2.1.2. (c) Fat 54
2.1.2(d) Electrolytes, vitamin and trace elements 55

2.1.2 (e) Energy requirments 57
2.1.2 (f) Fluid requirment 57
2.1.3 The parenteral nutrition product in Malaysian hospitals 58
2.1.4 Route of parenteral nutrition 59

2.1.5 Outcomes of parenteral nutrition 60

2.1.6 Complication of parenteral nutrition 61

2.1.6 (a) Mechanical 62

2.1.6 (b) Infection 63
2.1.6 (c) Metabolic 65
2.1.7 Monitoring of parenteral nutrition 66

2.1.8 Cost of parenteral nutrition 66

2.1.9 Problem statement 68

2.1.10 Rationale of the study 69

2.1.11 Objectives 70

2.1.12 Scope (contribution) of the study 70

2.1.13 Justification of the study 70

2.2 Methodology 72

2.2.1 Introduction 72

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2.2.2 Development of data collection form 72

2.2.3 The pilot study 73

2.2.3 (a) Data analysis of the pilot study 73

2.2.3 (b) Result of the pilot study 73

2.2.3 (c) Discussion of pilot study 75

2.2.3 (d) Conclusion 76

2.2.4 The cost of solutions 76

2.2.5 Study design of the comparative study 79

2.2.6 Sites of the comparative study 79

2.2.7 Determination of sample size of comparatve study 79

2.2.8 Calculation of power and sample size of HPP 80

2.2.8 (a) Power calculation 80

2.2.8 (b) Calculation of power and sample size of HUSM 82

2.2.8 (c) Calculation of power and sample size of HUKM 84

2.2.8 (d) Calculation of power and sample size of UMMC 86

2.2.9 Subjects 87

2.2.10 Inclusion criteria 87

2.2.11 Execlusion criteria 88

2.2.12 Data analysis 88

2.2.12 (a) Two way ANOVA 88

2.2.12 (b) Pearson chi square 89

2.3 Results and discussions 91

2.3.1 Introduction 91

2.3.2 Characterstics of PN patients according to hospital 91
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2.3.3 Diagnosis of PN patients 92

2.3.4 Reasons of PN patients 93

2.3.5 Diagnosis and reasons. 93

2.3.6 Outcome of PN patients 96

2.3.7 Complications due to PN 97

2.3.8 Type of complications & factors associated with complications 98

2.3.9 The route of PN 106

2.3.10 The cost per day 107

2.3.11 The duration of PN 108

2.3.12 Energy requirements of PN 109

2.3.13 Volume prepared of PN 110

2.3.14 Macronutrient requirement 112

2.3.14 (a) Glucose supplement of PN 112

2.3.14 (b) AA supplement of PN 113

2.3.14 (c) Lipid supplement of PN 115

2.3.15 Vitamin requirements of PN 118

2.3.16 Trace elements requirements of PN 120

2.3.17 Electrolyte requirements of PN 121

2.3.17 (a) Sodium requirement of PN 121

2.3.17 (b) Potassium requirement of PN 123

2.3.17 (c) Magnesium requirement of PN 125

2.3.17 (d) Calcium requirement of PN 127

2.3.17 (e) Phosphate requirement of PN 128

2.3.17 (f) Chloride supplement in PN 130
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