Comment on \u3ci\u3eSmall Bowel Necrosis\u3c/i\u3e

Comment on the Article Small bowel necrosis associated with postoperative jejunal tube feeding

Total Nutrient Admixtures (3-in-1): Pros vs Cons for Adults

Total nutrient admixture (TNA) is a complete parenteral nutrition (PN) formulation composed of all macronutrients, including dextrose, amino acids, and intravenous fat emulsions (IVFE), in one bag. The TNA may be safely administered to the patient, with all components aseptically compounded and minimal administration manipulation required, lending itself to decreases in risks of catheter contamination and patient infections. The TNA is compatible and stable at recommended concentrations, and since the IVFE is in the TNA, it is infused at slower rates, allowing for better fat clearance. The TNA offers convenience of administration and a potential cost savings to the healthcare institution both directly and indirectly. Unfortunately, the TNA is not without concerns. At low macronutrient concentrations (lower than recommended), the formulation is compromised. Greater divalent and monovalent cation amounts and increased concentrations of phosphate and calcium may destabilize the TNA or result in precipitation, respectively. With the addition of IVFE in the TNA, catheter occlusion is greater and larger pore size filters are necessary, resulting in less microbial elimination. Determining if the implementation of the TNA is appropriate for an institution requires a recognition of the advantages and disadvantages of the TNA as well as an understanding of the institution’s patient population and their nutrition requirements

Anabolic agents: Adjuncts to nutrition support

Anabolic agents as adjuncts to nutrition support therapy have been used to improve malnutrition and establish anabolism. Growth hormone, insulin-like growth factor, and anabolic steroids have been studied for their potential to reverse the catabolic process and promote anabolism. This paper reviews several anabolic agents and their possible role in nutrition support therapy

Nutrition in the critically ill patient

Critical illness presents with the classic response to stress, including hypermetabolism and increased catabolism, resulting in a negative energy and nitrogen balance. These harmful events initiate the immunological response, starting with the systemic inflammatory response syndrome, which, if not resolved, may lead to multiple organ dysfunction syndrome (MODS). Furthermore, patients who do not develop early MODS manifest a compensation anti-inflammatory response syndrome, which suppresses immunity and predisposes the patient to sepsis, thereby ­increasing the risk of late MODS and ultimately death. The use of specialized nutrition support, including enteral nutrition (EN) and parenteral nutrition (PN), has been initiated in an attempt to preserve muscle wasting and decrease catabolic response. Other implementations, including hypocaloric feeding and immune-enhancing agents, have also been investigated for their help in improving outcomes in the critically ill patient

Compounding vs Standardized Commercial Parenteral Nutrition Product: Pros and Cons

Standardized commercial parenteral nutrition (PN) formulations have advantages and disadvantages as compared with PN formulations compounded using an automated compounding device. These advantages and disadvantages are discussed along with the supporting available research

Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient’s underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. Additionally, understanding the macro- and micronutrient modifications and electrolyte and vitamin alterations that should be implemented are vital for better patient outcomes

Does the quantity of enteral nutrition affect outcomes in critically ill trauma patients?

Abstract from Clinical Nutrition Week, Orlando, FL, January 29-February 2, 2005

Self-assessed proficiency and application of various skills learned during postgraduate pharmacy teaching skills development programs

The purpose of this study was to identify teaching skills commonly taught during the postgraduate pharmacy teaching skills development programs, to describe trainees\u27 perceived teaching proficiency, and the extent to which the learned teaching skills are applied in trainees\u27 current positions. An online survey was developed for pharmacists who completed postgraduate teaching skills development programs. The survey included demographic and program queries as well as questions on 23 teaching skills. Participants self-assessed their proficiency in and application of their learned teaching skills. The online survey resulted in 122 qualified responses. After training, the perceived proficiency in nearly all 23 teaching skills was high; however, the scores for application of teaching skills were significantly lower. A majority (91.7%) of survey respondents were engaged in experiential education. There is wide variability among the postgraduate pharmacy teaching skills development programs. Though the trainees perceived their proficiency in teaching skills to be high, the acquired teaching skills were underused

A comparison of efficacy of heparin 0.5 unit/ml versus heparin 1 unit/mL in parenteral nutrition administrated in the neonatal population

Abstract from Clinical Nutrition Week, Las Vegas, NV, February 8-10, 2010