Safety in parenteral nutrition compounding.

Parenteral nutrition (PN) compounding is a complex process that requires knowledge and training to ensure the safety and efficacy of this form of nutrition support therapy. Unfortunately, errors and lack of adherence to safe PN compounding recommendations and sterile compounding requirements have resulted in patient injury and death. These lapses in the safe provision of PN have been the result of various factors, including a lack of understanding of PN compatibility, stability, and sterility requirements, as well as drug product shortages and order entry errors. This review will describe the current challenges with the education and training regarding PN compounding, compatibility and stability of PN admixtures, simultaneous administration of nonnutrient medications with PN admixtures, and specific challenges with special populations such as neonates, pediatrics, and those receiving home care.

Effect of fish oil supplement administration method on tolerability and adherence: a randomized pilot clinical trial.

OBJECTIVES: Anecdotally, several strategies have been suggested in order to improve tolerability of fish oil supplements, but there is little evidence supporting any of these strategies. The aim of this study was to determine if there is a difference among four methods of oral administration of fish oil supplementation in terms of tolerability and adherence. METHODS: A randomized, prospective, open-label, four-arm pilot study was conducted on 60 healthy adult subjects randomized to different fish oil supplement administration methods with (1) milk, (2) food, (3) an empty stomach, and (4) frozen capsules prior to ingestion. Each subject was instructed to take two capsules three times daily for 30 consecutive days. Adherence was assessed by pill counts. Adverse effects were assessed by survey and patient exit interview. RESULTS: No apparent differences were demonstrated among the four administration groups in terms of adherence, reasons for non-adherence, or self-reported adverse effects. CONCLUSIONS: Method of administration did not affect rates of adherence or incidence of adverse effects in a small cohort of healthy adults taking fish oil supplement capsules for 30 days. TRIAL REGISTRATION: ClinicalTrials.gov NCT01471366. Registered November 16, 2011.

ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text].

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

Acid-base disorders: learning the basics.

Nutrition support practitioners should be confident in their ability to recognize and treat various metabolic and respiratory disorders encountered in daily practice. A clinician's comprehension of the underlying physiologic processes and/or exogenous causes that occur during acid-base disorders is essential when making therapeutic decisions regarding fluids, parenteral nutrition, and electrolyte management. This invited review will discuss basic metabolic and respiratory disorders while briefly addressing mixed acid-base disorders.

Medical therapy for acquired urinary incontinence in dogs.

The objective of this case report was to review acquired canine urethral incontinence in a case of a 2-year-old beagle that presented for inappropriate urination. Commercially available medications, as well as compounded medical therapeutic options, were reviewed. Diagnostic results revealed cystitis, which responded to the prescribed antibiotics. The incontinence issue remained. Compounded diethylstilbestrol was prescribed and dispensed to achieve successful clinical results. The role of the compounding pharmacist was vital to achieve appropriate dosing of a drug no longer commercially available.

Visual field defects and the risk of motor vehicle collisions among patients with glaucoma.

PURPOSE: To evaluate the association between visual field defects in the central 24 degrees field and the risk of motor vehicle collisions (MVCs) among patients with glaucoma. METHODS: A nested case-control study was conducted in patients with glaucoma aged 55 or more. Cases were patients who were involved in a police-reported motor vehicle collision (MVC) between January 1994 and June 2000; controls were those who had not experienced an MVC at the time of their selection. For each patient, an Advanced Glaucoma Intervention Study (AGIS) score was calculated on automated visual fields collected with the 24-2 or 3-2 programs. RESULTS: With respect to the better-eye AGIS score, compared with patients with no visual field defect, those with severe defects (scores 12-20) had an increased risk of an MVC (odds ratio [OR] 3.2, 95% CI 0.9-10.4), although the association was not statistically significant. Moderate (6-11) or minor field defects (1-5) in the better eye were not associated with the risk of involvement in a crash. In the worse eye, patients with moderate or severe field defects were at significantly increased risk of an MVC (OR 3.6, 95% CI 1.4-9.4 and OR 4.4, 95% CI 1.6-12.4, respectively) compared with those with no defects. Minor field defects in the worse eye did not increase risk of MVC (OR 1.3, 95% CI 0.5-3.4). CONCLUSIONS: Patients with glaucoma who have moderate or severe visual field impairment in the central 24 degrees radius field in the worse-functioning eye are at increased risk of involvement in a vehicle crash.

Is glaucoma associated with motor vehicle collision involvement and driving avoidance?

PURPOSE: To evaluate the association between the diagnosis of glaucoma and motor vehicle collision (MVC) involvement and driving avoidance in drivers aged > or =50 years. METHODS: Two groups of patients, one with glaucoma and one without, were identified in three university-affiliated eye care practices. Demographic, clinical, and driving characteristics were obtained by chart abstractions and a patient survey. Information regarding MVC involvement was obtained from police records. RESULTS: Patients with glaucoma were less likely (relative risk [RR], 0.67; 95% confidence interval [CI], 0.47-0.97) to be involved in collisions than patients without glaucoma. There was no difference between the at-fault crash rates of the patients with glaucoma and those without (RR, 1.22; 95% CI, 0.67-2.22). Patients with glaucoma had significantly higher levels of avoidance for driving at night (odds ratio [OR], 2.06; 95% CI, 1.11-3.82), driving in fog (OR, 3.80; 95% CI, 1.93-7.48), driving in the rain (OR, 2.99; 95% CI, 1.32-6.76), driving during rush hour (OR, 2.24; 95% CI, 1.16-4.34), driving on the highway (OR, 2.81; 95% CI, 1.19-6.64), and high density driving (OR, 2.88; 95% CI, 1.28-6.46). These associations were adjusted for demographic and medical characteristics as well as visual acuity. CONCLUSIONS: Older persons with glaucoma drive at least as safely as, if not more safely than, older persons without glaucoma.