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Aspects of home parenteral nutrition in Scotland

Hallum, Nicola S. (2010) Aspects of home parenteral nutrition in Scotland. MSc(R) thesis, University of Glasgow.

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Abstract

Background and Aims: Home Parenteral Nutrition (HPN) has been a major advance in the management of patients with gastrointestinal failure. It demands regular monitoring to ensure optimal intake, assess treatment response and minimise complications. The Scottish Home Parenteral Nutrition Managed Clinical Network (MCN) affords the opportunity to collect and analyse data about many aspects of HPN. The Network produced a guideline advising three monthly monitoring of biochemistry, micronutrients, vitamins, weight and anthropometry. This study firstly assesses the frequency and adequacy of monitoring of these complex patients and investigates any effect of this on complication rate. The second chapter is devoted to the outcome data of this geographical population and the comparison of survival figures to other intestinal failure (IF) centres. Lastly, hypermanganesemia is commonly reported during the follow up of HPN patients. Manganese (Mn) is added to parenteral nutrition in a multi trace element solution. Flexibility to alter the dose is limited. Manganese dosing and whole blood level is analysed to assess correlation. Other blood parameters are compared to assess any influence they may have on body manganese levels. Methods: All patients receiving HPN funded by the NHS (National Health Service) in Scotland are known to the MCN via the National Contract for provision of HPN. Data is collected in an MS Access database. Data was extracted from this and absent information sought by personal communication. Results: Monitoring of HPN patients across Scotland is performed regularly, however, only one third of patients met the 100 day standard. Consequences of this seemed negligible with no increase in complication rate of those reviewed less often. Outcome data is broadly comparable to large UK IF centres. Overall survival at 5 years is 77.2%. Outcome is dependent on primary disease diagnosis with Crohns disease and motility disorders having the best figures. Cause of death for the majority of patients (65%) is purely disease related rather than as a complication of HPN. Hypermanganesemia was found in 11 of 12 patients at least once during the study period. Whole blood manganese levels were not related to cumulative manganese dose, or blood parameters such as C reactive protein, ferritin or alkaline phosphatase. Conclusions: It may be clinically viable and economically sensible to decrease the frequency of monitoring of in HPN patients without detrimental effect. Complications are no more often found in patients reviewed with less frequency than those seen more often. A tailored approach to follow up and monitoring may be appropriate and is worth considering with respect to clinical workload and economic consequence. Survival in our Scottish HPN patient population is comparable to that of tertiary UK centres and European equivalents, despite our wide and unselected geographical population and the logistical difficulties it presents. Manganese levels are frequently high in our HPN patients. As yet, no convincing data exists to resolve the relevant clinical, biochemical or environmental factors. A multifactorial solution is anticipated.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Keywords: HPN, Home Parenteral Nutrition, monitoring, nutrition, outcomes, Manganese, micronutrients, Scotland, MCN, managed clinical network
Subjects: R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
Supervisor's Name: McKee, Dr. Ruth F.
Date of Award: 2010
Depositing User: Dr Nicola S Hallum
Unique ID: glathesis:2010-1724
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 07 Aug 2012
Last Modified: 10 Dec 2012 13:45
URI: http://theses.gla.ac.uk/id/eprint/1724

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