March 2005

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Clinical Nutrition Week Pearls

This issue of Clinical Pearls is dedicated to the pearls of nutritional wisdom picked up at Clinical Nutrition Week, a scientific and clinical forum held this year in Orlando, Florida. Under the oversight of the American Society for Parenteral and Enteral Nutrition ( www.clinnutr.org ), participating organizations included the American Society for Bariatric Surgery, the American Society for Gastrointestinal Endoscopy, the Canadian Society for Clinical Nutrition, Dietitians in Nutrition Support (a Practice group of the American Dietetic Association), the European Society for Parenteral and Enteral Nutrition, and the International Parenteral Nutrition Education and Methodology Advancement group.

Many sessions were dedicated to discussing the increasing number of severely overweight Americans and associated co-morbidities. Bariatric surgical interventions for the treatment of Morbid obesity (BMI>40) are now commonplace throughout the American medical community. The following are some clinically relevant “Pearls” on obesity and bariatric surgery noted at Clinical Nutrition Week:

  • In a recent study, it was shown that Bariatric surgery, which can cost from $20,000-$40,000, will usually pay for itself after 4 years due to a drastic decrease in obesity related co-morbidities. These include type-II diabetes, COPD, CHF, osteoarthritis, and sleep apnea. Some state insurance companies (i.e. Medicaid) are now covering this procedure based upon this data. [LD]
     
  • The highest number of bariatric surgeries are performed in the United States, followed by France. Gastric bypass is the most commonly performed type of bariatric procedure, and 62% are now done laproscopically. [DS]
     
  • 15-18 year olds whose weight is greater than the 85th percentile on pediatric growth charts have a 72% likelihood of adult obesity. [LD]
     
  • Bariatric surgeries are now being performed in teenagers when warranted (BMI > 70). Age is usually 16-17 years or older. [SP] • The main diagnosis for liver transplantation is not cirrhosis due to alcoholism or Hepatitis B, but is due to obesity-related fatty liver. [SP]
      
  • Pica, in the form of ice-eating, has been identified in females after undergoing bariatric surgery. Bariatric specialists believe it is due to iron deficiency. Bypassing most of the gastric mucosa results in decreased absorption and utilization of vitamin B-12 and iron, and increases the incidence of anemias. [SP]

And, some general pearls of wisdom:

  • Avoid overfeeding when providing enteral or parenteral nutrition: Know your reference ranges. [LD]
     
  • It is not uncommon to see elevations of liver enzymes in patients receiving parenteral nutrition, and the question remains: Does TPN cause hepatic complications? We can’t answer this for sure. To assume that the TPN is causing a rise in liver function tests may prevent evaluation for other causes of liver disease. [LJa]
     
  • Growth Hormone in conjunction with a healthy diet may help restore gut surface in patients with short bowel syndrome. Bowel adaptation and rehabilitation best occur within the first 6 months post-op. [LJo]
     
  • Proper nutrition has a role in the failing heart. Repleting patients with a combination of carnitine, coenzyme Q10, and taurine has shown improvement in cardiac function after CABG. [AN]
Continued from left column:
  • In a recent JPEN article, it was stated that one in ten patients will acquire an infection post admission to the hospital. In the late 1980's and early 1990's the nosocomial infection acquired was a UTI which has a low mortality rate. Today, the nosocomial infection is pneumonia which is associated with a much higher mortality rate. This data suggests that if a patient can be treated in the home, they should be. [LD]
      
  • Treating malnutrition is … 10% science, 10% experience, 10% skill, 20% patience, 50% attitude. ~ Stanley Dudrick MD FACS [AN]

Oley Pointers

A highlight of Clinical Nutrition Week is the annual presentation by members of the Oley Foundation ( www.oley.org ). Oley is a national, independent, non-profit organization that provides information and support for consumers of home parenteral and enteral nutrition (HPEN). Since 1983, the Oley Foundation has provided its services FREE of cost to consumers dependent on HPEN, their caregivers and clinicians. When asked what distinguishes a good home infusion provider from a GREAT home infusion provider, Oley members provided the following pointers:

  1. GREAT providers get orders right. Receiving the “right stuff” consistently builds confidence in the health care team.
      
  2. GREAT providers establish trust. Great home care providers, as an extension of the health care team, are knowledgeable about nutrition therapies. This allows the consumer to be comfortable when placing their lives in the hands of the agency.
      
  3. GREAT providers deliver on time. Great providers call the day before. They call the morning of, and they call 5 minutes before they get to the consumer’s home. When it comes to delivering medications or supplies, a provider can never “over-communicate”.
      
  4. GREAT providers communicate. Good care in the home begins and ends with good communication. From the physician to the dietitian to the pharmacy to the driver, it takes the entire health care team in constant communication to provide excellence in care. Having that personal touch is important; know a little about each consumer. Ask them about their life. Kids and pets are important. These folks want to live as normal and active a life as possible.
      
  5. GREAT providers care more about the patient than the bottom line. It is all about compassion and efficiency. One is not exclusive of the other.
      
  6. GREAT providers are preventative and not reactive. Consistent monitoring is essential for quick identification and correction of trends before problems ensue. Be a consumer advocate. Remember, the consumers’ lives are in the provider’s hands. [RE]

The GOLDEN rule is to treat others the way
YOU want to be treated. The PLATINUM rule is to treat others the way THEY want to be treated.

Whether it is anti-infectives. TPN, IVIG, or home chemotherapy, Option Care is the right choice. You may call us 24 hours a day, 7 days a week, for all your home infusion and specialty pharmacy needs.

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The articles herein are provided for general information and are not intended to provide specific advice or recommendations for any reader.