JPEN. Journal of parenteral and enteral nutrition
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JPEN J Parenter Enteral Nutr · Mar 2012
Comparative StudyGastrointestinal hormone concentrations associated with gastric feeding in critically ill patients.
Altered concentrations of ghrelin, motilin, and cholecystokinin (CCK) may contribute to gastric hypomotility. The aims of this study were to evaluate the concentrations of these hormones in patients tolerant and intolerant to gastric nutrition, assess the influence of prokinetic therapy on these hormone concentrations, determine the associations between these mediators and gastric emptying, and evaluate whether inflammation influences their concentrations. ⋯ Patients intolerant to gastric nutrition generate less acyl ghrelin, which may contribute to gastric hypomotility. Intolerance is not associated with altered concentrations of other hormones. Hormone concentrations are not influenced by prokinetic therapy.
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JPEN J Parenter Enteral Nutr · Mar 2012
Parenteral nutrition training for the pharmacy team: focus on pharmacy technicians.
Pharmacy technicians are integral to the success of parenteral compounding programs in pharmacies around the country. Their positions may vary depending on practice site, but technicians are critical to the pharmacy team, and it is imperative that they be appropriately trained to take on their roles and responsibilities. ⋯ All compounding personnel involved in the process of delivering PN, including technicians, must be trained on the proper techniques, applicable technology, and risk of errors. This article outlines the landscape of training as it specifically pertains to pharmacy technicians and shares proceedings from key pharmacy meetings in the past 5 years that advocate for national standards.
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JPEN J Parenter Enteral Nutr · Sep 2011
Nutrition delivery for obese ICU patients: delivery issues, lack of guidelines, and missed opportunities.
The most appropriate enteral formula for the severely obese population has yet to be determined. The obese patient in the intensive care unit (ICU) creates numerous difficulties for managing care, one being the ability to deliver appropriate and timely nutrition. Access for nutrition therapy, either enteral or parenteral, can also create a challenge. ⋯ Specific nutrients that may be beneficial in obesity include arginine, glutamine, leucine, L-carnitine, lipoic acid, S-adenosylmethionine, and betaine. Certain trace minerals such as magnesium, zinc, and selenium may also be of value in the obese population. The concept of a specific bariatric formulation for the ICU setting is theoretically sound, is scientifically based, and could be delivered to patients safely.
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JPEN J Parenter Enteral Nutr · May 2011
Randomized Controlled TrialEffects of perioperative synbiotic treatment on infectious complications, intestinal integrity, and fecal flora and organic acids in hepatic surgery with or without cirrhosis.
The aim of this study was to assess the effect of preoperative and postoperative synbiotic treatment in hepatectomy patients with or without liver cirrhosis. ⋯ Perioperative synbiotic treatment attenuated the decrease in intestinal integrity and reduced the rate of infectious complications in patients with or without liver cirrhosis who underwent hepatic surgery.
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JPEN J Parenter Enteral Nutr · Nov 2010
Review Comparative StudyGuidelines, guidelines, guidelines: what are we to do with all of these North American guidelines?
Over the past decade, clinical guidelines for nutrition therapy in the critically ill have been developed by different North American societies. To avoid target audience confusion and uncertainty, there is a need to undergo a review of the content of these guidelines. In this review, the authors compared the grading systems, the levels of evidence used, and the content of North American nutrition clinical guidelines. ⋯ These major differences can be attributed to the admission of different populations, lower levels of evidence or expert opinion into the guideline production process, lack of clarity in the link between the evidence and the recommendation, and lack of uniformity in the reporting of levels of evidence and grades of recommendation. The authors have identified the need for the North American nutrition organizations to harmonize the development of future nutrition guidelines in a timely way, so that they remain current and up-to-date. Furthermore, guideline users need to be aware of the dissimilarities in these guidelines before applying the recommendations to their daily practice.