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Home parenteral nutrition: a systematic review
D M Richards1, J J Deeks, T A Sheldon
1University of Manchester Intestinal Failure Unit, Hope Hospital, Salford.
Health Technology Assessment (Winchester, England)
|January 1, 1997
Summary
Home parenteral nutrition (HPN) is effective for benign intestinal failure, though evidence for its use in malignant conditions is limited. Further research is needed to address these gaps in HPN effectiveness and patient outcomes.
Area of Science:
- Medical Technology
- Clinical Nutrition
- Gastroenterology
Background:
- Home parenteral nutrition (HPN) provides nutritional support for patients unable to absorb nutrients orally.
- Evidence on HPN effectiveness, patient experience, organization, and cost-effectiveness requires synthesis.
Purpose of the Study:
- To review scientific evidence on home parenteral nutrition (HPN).
- To answer specific research questions regarding HPN effectiveness, patient populations, program organization, and cost-effectiveness.
Main Methods:
- Comprehensive literature search across multiple electronic databases and journals.
- Inclusion of studies with broad criteria due to varying study quality.
- Data extraction using standardized forms, with checks by a second researcher.
Main Results:
- HPN is primarily used in younger patients, with variations in underlying diseases by country.
- Complication rates are generally acceptable and related to central venous catheters.
- Survival is good for benign conditions but poor for malignant diseases and AIDS; quality of life is reasonable for benign cases.
- HPN is more cost-effective than inpatient care, but comparative studies are scarce.
Conclusions:
- Evidence supports the use of HPN for benign intestinal failure.
- Significant evidence gaps exist for HPN in malignant disease and AIDS.
- Further research is recommended to address these gaps in HPN provision and effectiveness.