Entrustable professional activities-based objective structured clinical examinations in a pharmacy curriculum.

BACKGROUND: The integration of Objective Structured Clinical Examinations (OSCEs) within the professional pharmacy program, contributes to assessing the readiness of pharmacy students for Advanced Pharmacy Practice Experiences (APPEs) and real-world practice. METHODS: In a study conducted at an Accreditation Council for Pharmacy Education (ACPE)-accredited Doctor of Pharmacy professional degree program, 69 students in their second professional year (P2) were engaged in OSCEs. These comprised 3 stations: best possible medication history, patient education, and healthcare provider communication. These stations were aligned with Entrustable Professional Activities (EPAs) and Ability Statements (AS). The assessment aimed to evaluate pharmacy students' competencies in key areas such as ethical and legal behaviors, general communication skills, and interprofessional collaboration. RESULTS: The formulation of the OSCE stations highlighted the importance of aligning the learning objectives of the different stations with EPAs and AS. The evaluation of students' ethical and legal behaviors, the interprofessional general communication, and collaboration showed average scores of 82.6%, 88.3%, 89.3%, respectively. Student performance on communication-related statements exceeded 80% in all 3 stations. A significant difference (p < 0.0001) was found between the scores of the observer and the SP evaluator in stations 1 and 2 while comparable results (p = 0.426) were shown between the observer and the HCP evaluator in station 3. Additionally, a discrepancy among the observers' assessments was detected across the 3 stations. The study shed light on challenges encountered during OSCEs implementation, including faculty involvement, resource constraints, and the necessity for consistent evaluation criteria. CONCLUSIONS: This study highlights the importance of refining OSCEs to align with EPAs and AS, ensuring a reliable assessment of pharmacy students' clinical competencies and their preparedness for professional practice. It emphasizes the ongoing efforts needed to enhance the structure, content, and delivery of OSCEs in pharmacy education. The findings serve as a catalyst for addressing identified challenges and advancing the effectiveness of OSCEs in accurately evaluating students' clinical readiness.

Mapping and assessment of personal and professional development skills in a pharmacy curriculum.

BACKGROUND: Health sciences programs are increasingly expanding their curricula to bridge foundational scientific knowledge with needed skills to practice and patient care. The primary objectives of this study are to 1) assess whether the personal and professional development (PPD) subdomains (self-assessment, leadership, innovation and entrepreneurship, and professionalism) are integrated in a pharmacy curriculum; and 2) identify any gaps related to the subdomains' learning objectives. METHODS: Four different mapping activities were completed to create a comprehensive mapping plan regarding the integration of the PPD subdomains in the curriculum. The first mapping activity entailed matching the school's program educational outcomes (PEOs) to these subdomains (Step 1). Mapping of the enacted curriculum by faculty (Step 2) and learned curriculum by students (Step 3) were also completed in order to evaluate the integration of these subdomains in the curriculum. Finally, Step 4 involved mapping of the assessed curriculum by analyzing the progress of students on PPD-related competencies using standardized scoring rubrics and the correlation between students' and facultys' assessments with regard to matching competencies. The Cochrane's Q test and the Cohen's kappa coefficient were used in the statistical analysis of parametric data. RESULTS: The subdomains were found to be woven across curricular, co-curricular, and extra-curricular activities based on the four different mapping activities. Faculty and students agreed that the PPD competencies are integrated in the curriculum; provided example courses, experiences and activities; and identified areas of further improvements. The completed mapping activities drove the development of action plans for remediation of identified gaps in the curriculum. CONCLUSION: Mapping activities showed the sequential integration of the PPD skills at different depths and breadths in the curriculum. This study provides an example to health sciences schools on the incorporation of the PPD skills in their curricular, co-curricular and extra-curricular activities as current accreditation standards have directed Pharmacy programs to integrate and enforce them in their curricula.

An elective course on career opportunities for pharmacy students.

BACKGROUND AND PURPOSE: There is limited literature describing the outcomes of formal career guidance in pharmacy programs. This study assessed the course outcomes including students' satisfaction, achievement of the learning objectives and scoring on assignments. EDUCATIONAL ACTIVITY AND SETTING: A 1-credit elective course aims at providing second- and third-year professional pharmacy students (P2 and P3) to career guidance. The main topics address career planning and paths, communication skills, personal and professional development, leadership and entrepreneurship. Included are written assignments, oral group presentations and mock interviews. FINDINGS: Data on 303 students, including 279 P2 and 24 P3, between 2012 and 2021 were analyzed using course evaluations, direct assessment and scoring. Average evaluations ratings were consistently above 4 on a 5-point scale including the clarity of the course policies and procedures (4.61) and its objectives and requirements (4.59), organization (4.58), instructors' simulated questions, responses, discussion and openness to other viewpoints (4.57) and quality (4.5). Students found the experience to be interesting and relevant to pharmacy practice. All students scored above 70% on the course assignments. DISCUSSION: Students were satisfied with the course and gave high ratings to the course content, delivery and in meeting its learning objectives. They scored high on the different course assignments. These findings are similar to the results of other studies reporting students' satisfaction with career guidance. SUMMARY: The career opportunities course is popular among pharmacy students who consistently reported their satisfaction with its content, design and delivery.

Pharmacy students' knowledge, perceptions, and satisfaction in a nutrition course.

BACKGROUND AND PURPOSE: Little is known about nutrition education in pharmacy programs. This study reports on the outcomes assessment of pharmacy students' knowledge, perceptions, and satisfaction in a clinical nutrition course. EDUCATIONAL ACTIVITY AND SETTING: A 2-credit required course in clinical nutrition and diet therapy provides third-year professional pharmacy students with knowledge on various diet and nutrition topics. These relate to nutrition concepts in health and disease, the prevention and treatment of diet- and nutrition-related health conditions, and enteral and parenteral nutrition. FINDINGS: Between the academic years 2012 and 2021, 720 students were enrolled in the course. Direct assessment data were collected from 227 students, and indirect assessment data from 173 students. On average, 85.7% of students acquired the necessary knowledge on all 23 course learning objectives. Average course evaluation ratings by students on a 5-point Likert scale (strongly disagree = 1; disagree = 2; somewhat agree = 3; agree = 4; strongly agree = 5) were high (4.43). High ratings were also recorded for students' satisfaction with the course structure (4.46) and teaching effectiveness (4.39). Students appreciated the clear presentation of the course learning objectives, requirements, and teaching effectiveness. They also acknowledged the quality of the learning experience and the course's relevance to pharmacy. DISCUSSION: Students highly rated the course in achieving its learning objectives in addition to their satisfaction with its content, structure, delivery, and relevance to pharmacy education and practice. Furthermore, the course content addressed the accreditation requirements for nutrition education and covered the topics listed in the American College of Clinical Pharmacy (ACCP) Pharmacotherapy Didactic Curriculum Toolkits. SUMMARY: The clinical nutrition and diet therapy course was well received. Educating pharmacy students on diet and nutrition prepares graduates for expanding their role in these domains in the community, hospital and clinical practice settings.

Emotional intelligence and professional identity formation in pharmacy education.

INTRODUCTION: Considering the various professional roles of pharmacists, pharmacy students and pharmacists have had difficulty identifying with a clear professional identity. Thereby there is a need for a professional identity formation (PIF) that conveys a consistent message about the role and value of pharmacists. Having a clear professional identity may also be a driver to advance the pharmacy profession. While achieving PIF is a challenging path, one element that conceivably contributes to PIF is emotional intelligence (EI). EI is acquired through life experiences and relates to personal and social awareness and the management of emotions and relationships. EI is critical for personal and professional success. PERSPECTIVE: Pharmacy students are exposed to different pharmacists' professional identities. This faces them with challenges as they try to incorporate their roles and expectations into practice. Integrating the core elements of EI into pharmacy education through a variety of teaching and learning methods is essential in the PIF of pharmacy students. PIF will enable pharmacy students to better associate with the profession by "thinking, acting, and feeling like a pharmacist." IMPLICATIONS: Both EI and PIF need to be integrated in pharmacy curricula. However, there is paucity of literature on how to best develop, integrate and assess EI and PIF. Therefore, a collaborative comprehensive approach by the pharmacy profession is necessary to that end.

Oxandrolone treatment in adults with severe thermal injury.

Severe thermal injury is associated with hypermetabolism and hypercatabolism, leading to skeletal muscle breakdown, lean body mass loss, weight loss, and negative nitrogen balance. Muscle protein catabolism in patients with severe thermal injury is the result of stress-induced increased release of cytokines and counterregulatory hormones. Coupled with decreased serum anabolic hormone concentrations such as testosterone and growth hormone along with the presence of insulin resistance, anabolism in patients with severe thermal injury is inefficient or impossible during the acute postburn period. This causes difficulty in restoring lean body mass and regaining lost body weight, as well as poor healing of the burn wound and delayed patient recovery. Oxandrolone, a synthetic derivative of testosterone, has been used in adult patients with severe thermal injury to enhance lean body mass accretion, restore body weight, and accelerate wound healing. In clinical studies, oxandrolone 10 mg orally twice/day improved wound healing, restored lean body mass, and accelerated body weight gain. During the rehabilitation period, oxandrolone therapy with adequate nutrition and exercise improved lean body mass, increased muscle strength, and restored body weight. However, most data on oxandrolone use in adult patients with severe thermal injury are derived from single-center studies, many of which enrolled a relatively small number of subjects and some of which had a poor design. Multicenter, prospective, randomized studies are needed to better define the optimal oxandrolone dosage and to confirm the efficacy and safety of this drug in adult patients with severe thermal injury.

Amino Acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy.

Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress-induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.

Oxandrolone in pediatric patients with severe thermal burn injury.

OBJECTIVE: To review the role of oxandrolone in pediatric patients with severe thermal burn injury. DATA SOURCES: MEDLINE (1950-April 2008) and Science Citation Index (1900-April 2008) searches were performed using the key terms oxandrolone, burn, and children. STUDY SELECTION AND DATA EXTRACTION: All English-language articles that evaluated the efficacy and safety of oxandrolone in pediatric patients with severe thermal burn injury were included in this review. DATA SYNTHESIS: Oxandrolone stimulates protein synthesis by binding to androgen receptors. The efficacy and safety of adjunct oxandrolone therapy in pediatric patients (20%) were evaluated in 8 clinical studies. Oral oxandrolone 0.1 mg/kg twice daily increased protein synthesis, lean body mass accretion, and muscle strength; improved serum visceral protein concentrations; promoted weight gain; and increased bone mineral content. During the postburn rehabilitation period, oxandrolone 0.1 mg/kg/day improved muscle strength, especially when combined with exercise. Based on clinical studies, oxandrolone 0.1 mg/kg twice daily is safe when given for up to 12 months. However, mild increases in serum liver transaminase concentrations and reversible sexual changes were observed during therapy. Although data on the efficacy and safety of oxandrolone in severely burned children are supported by prospective, randomized, controlled studies, limitations of available data are that they originated from a single study center and that wound healing measurement is lacking in children with severe thermal burns. CONCLUSIONS: The benefits of adjunct oxandrolone therapy in severely burned pediatric patients have been demonstrated in the acute postburn injury and long-term postburn rehabilitation periods. Close monitoring of liver function, sexual development, and growth pattern is recommended during oxandrolone treatment.

Ursodiol in patients with parenteral nutrition-associated cholestasis.

OBJECTIVE: To review the role of ursodeoxycholic acid (ursodiol) in treating parenteral nutrition-associated cholestasis (PNAC). DATA SOURCES: A MEDLINE (1950-May 2007) search was performed using the key terms parenteral nutrition, cholestasis, ursodeoxycholic acid, and ursodiol. STUDY SELECTION AND DATA EXTRACTION: All English-language articles that evaluated the safety and efficacy of ursodiol for PNAC were included in this review. DATA SYNTHESIS: The benefits of exogenous ursodiol administration in the treatment of cholestasis can be explained by its alteration of effects on bile composition and flow and provision of cytoprotective, membrane stabilizing, and immunomodulatory effects. Two animal studies, 2 case reports, and 6 human studies (2 prospective and 3 retrospective pediatric studies, 1 adult prospective study) evaluated the efficacy of ursodiol in patients with PNAC. Ursodiol 10-30 mg/kg/day in children and 10-15 mg/kg/day in adults administered in 2-3 doses improved the biochemical and clinical signs and symptoms of PNAC. However, short-term improvement in biochemical parameters may not necessarily predict the outcome of PNAC patients. At recommended doses, ursodiol may not be effective in patients with short bowel syndrome or in those with resected terminal ileum because of reduced ursodiol absorption. Studies supporting the efficacy of ursodiol in treatment of PNAC are limited by small sample size, absence of randomization and controls, short duration, and lack of accountancy to confounding variables. Large, prospective, randomized, placebo-controlled, long-term follow-up studies evaluating the efficacy and optimal dosing and duration of ursodiol therapy for PNAC are not yet available. CONCLUSIONS: Ursodiol may improve the biochemical signs and clinical symptoms of PNAC. However, optimal dosing, timing, duration of therapy, and long-term effects on PNAC outcome and prognosis require further studies.

Relationship between hyperglycemia and infection in critically ill patients.

Hyperglycemia is a common problem encountered in hospitalized patients, especially in critically ill patients and those with diabetes mellitus. Uncontrolled hyperglycemia may be associated with complications such as fluid and electrolyte disturbances and increased infection risk. Studies have demonstrated impairment of host defenses, including decreased polymorphonuclear leukocyte mobilization, chemotaxis, and phagocytic activity related to hyperglycemia. Until 2001, hyperglycemia (blood glucose concentrations up to 220 mg/dl) had been tolerated in critically ill patients not only because high blood glucose concentrations were believed to be a normal physiologic reaction in stressed patients and excess glucose is necessary to support the energy needs of glucose-dependent organs, but also because the true significance of short-term hyperglycemia was not known. Recent clinical data show that the use of intensive insulin therapy to maintain tight blood glucose concentrations between 80 and 110 mg/dl decreases morbidity and mortality in critically ill surgical patients. Intensive insulin therapy minimizes derangements in normal host defense mechanisms and modulates release of inflammatory mediators. The principal benefit of intensive insulin therapy is a decrease in infection-related complications and mortality. Further research will define which patient populations will benefit most from intensive insulin therapy and firmly establish the blood glucose concentration at which benefits will be realized.

Treatment of electrolyte disorders in adult patients in the intensive care unit.

PURPOSE: The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. SUMMARY: Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. CONCLUSION: Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy.

Acute renal failure (ARF) is rarely an isolated process but is often a complication of underlying conditions such as sepsis, trauma, and multiple-organ failure in critically ill patients. As such, concomitant clinical conditions significantly affect patient outcome. Poor nutritional status is a major factor in increasing patients' morbidity and mortality. Malnutrition in ARF patients is caused by hypercatabolism and hypermetabolism that parallel the severity of illness. When dialytic intervention is indicated, continuous renal replacement therapy (CRRT) is a commonly used alternative to intermittent hemodialysis because it is well tolerated by hemodynamically unstable patients. This paper reviews the metabolic and nutritional alterations associated with ARF and provides recommendations regarding the nutritional, fluid, electrolyte, micronutrient, and acid-base management of these patients. The basic principles of CRRT are addressed, along with their nutritional implications in critically ill patients. A patient case is presented to illustrate the clinical application of topics covered within the paper.

Review of the refeeding syndrome.

Refeeding syndrome describes a constellation of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications. We reviewed literature on refeeding syndrome and the associated electrolyte abnormalities, fluid disturbances, and associated complications. In addition to assessing scientific literature, we also considered clinical experience and judgment in developing recommendations for prevention and treatment of refeeding syndrome. The most important steps are to identify patients at risk for developing refeeding syndrome, institute nutrition support cautiously, and correct and supplement electrolyte and vitamin deficiencies to avoid refeeding syndrome. We provide suggestions for the prevention of refeeding syndrome and suggestions for treatment of electrolyte disturbances and complications in patients who develop refeeding syndrome, according to evidence in the literature, the pathophysiology of refeeding syndrome, and clinical experience and judgment.

Parenteral nutrition-associated liver complications in children.

Parenteral nutrition is a life-saving therapy for patients with intestinal failure. It may be associated with transient elevations of liver enzyme concentrations, which return to normal after parenteral nutrition is discontinued. Prolonged parenteral nutrition is associated with complications affecting the hepatobiliary system, such as cholelithiasis, cholestasis, and steatosis. The most common of these is parenteral nutrition-associated cholestasis (PNAC), which may occur in children and may progress to liver failure. The pathophysiology of PNAC is poorly understood, and the etiology is multifactorial. Risk factors include prematurity, long duration of parenteral nutrition, sepsis, lack of bowel motility, and short bowel syndrome. Possible etiologies include excessive caloric administration, parenteral nutrition components, and nutritional deficiencies. Several measures can be undertaken to prevent PNAC, such as avoiding overfeeding, providing a balanced source of energy, weaning parenteral nutrition, starting enteral feeding, and avoiding sepsis.

Metabolic complications of parenteral nutrition in adults, part 1.

PURPOSE: Common metabolic complications associated with parenteral nutrition (PN) are reviewed, and the consequences of overfeeding and variables for patient monitoring are discussed. SUMMARY: Although PN is a lifesaving therapy in patients with gastrointestinal failure, its use may be associated with metabolic, infectious, and technical complications. The metabolic complications associated with PN in adult patients include hyperglycemia, hypoglycemia, hyperlipidemia, hypercapnia, refeeding syndrome, acid-base disturbances, liver complications, manganese toxicity, and metabolic bone disease. These complications may occur in the acute care or chronic care patient. The frequency and severity of these complications depend on patient- and PN-specific factors. Proper assessment of the patient's nutritional status; tailoring the macronutrient, micronutrient, fluid, and electrolyte requirements on the basis of the patient's underlying diseases, clinical status, and drug therapy; and monitoring the patient's tolerance of and response to nutritional support are essential in avoiding these complications. Early recognition of the signs and symptoms of complications and knowledge of the available pharmacologic and nonpharmacologic therapies are essential to proper management. PN should be used for the shortest period possible, and oral or enteral feeding should be initiated as soon as is clinically feasible. The gastrointestinal route remains the most physiologically appropriate and cost-effective way of providing nutritional support. CONCLUSION: PN can lead to serious complications, many of which are associated with overfeeding. Close management is necessary to recognize and manage these complications.

Metabolic complications of parenteral nutrition in adults, Part 2.

PURPOSE: Common metabolic complications associated with parenteral nutrition (PN) are reviewed, and the consequences of overfeeding and variables for patient monitoring are discussed. SUMMARY: Although PN is a lifesaving therapy in patients with gastrontestinal failure, its use may be associated with metabolic, infectious, and technical complications. The metabolic complications associated with PN in adult patients include hyperglycemia, hypoglycemia, hyperlipidemia, hypercapnia, refeeding syndrome, acid-base disturbances, liver complications, manganese toxicity, and metabolic bone disease. These complications may occur in the acute care or chronic care patient. The frequency and severity of these complications depend on patient- and PN-specific factors. Proper assessment of the patient's nutritional status; tailoring the macronutrient, micronutrient, fluid, and electrolyte requirements on the basis of the patient's underlying diseases, clinical status, and drug therapy and monitoring the patient's tolerance of and response to nutritional support are essential in avoiding these complications. Early recognition of the signs and symptoms of complications and knowledge of the available pharmacologic and nonpharmacologic therapies are essential to proper management. PN should be used for the shortest period possible, and oral or enteral feeding should be initiated as soon as is clinically feasible. The gastrointestinal route remains the most physiologically appropriate and cost-effective way of providing nutritional support. CONCLUSION: PN can lead to serious complications, many of which are associated with overfeeding. Close management is necessary to recognize and manage these complications.

In vitro clearance of trace elements via continuous renal replacement therapy.

OBJECTIVE: Trace element loss during continuous renal replacement therapy in patients with acute renal failure has not been quantified sufficiently. DESIGN: Trace element loss was quantified using an in vitro model of continuous venovenous hemofiltration. Bovine blood was used for the experiment, and the plasma was analyzed for its chromium, copper, selenium, manganese, and zinc content. Two different polysulfone hemodiafilters, a low-flux F8 and high-flux F70 were used, and tested at two different ultrafiltrate flow rates of 1 L/hr and 2 L/hr, respectively. Trace element concentrations in the plasma and ultrafiltrate were analyzed using inductively coupled plasma mass spectrometry. The sieving coefficient and clearance of each trace element were calculated and compared between the two hemodiafilters. SETTING: In vitro bovine model of continuous venovenous hemofiltration. PATIENTS OR OTHER PARTICIPANTS: Not applicable. RESULTS: Mean sieving coefficients of both F8 and F70 hemodiafilters were similar for each trace element. Copper, chromium, manganese, selenium, and zinc all were detected in the ultrafiltrate. Estimated trace element loss using typical trace element blood concentrations and study-derived sieving coefficients suggest that daily losses of selenium are greater than what is replenished with a standard daily trace element supplement in total parenteral nutrition. CONCLUSION: These data suggest that the degree of continuous venovenous hemofiltration clearance chromium, copper, selenium, manganese, and zinc differ between elements and that selenium and copper might need to be replaced with doses that exceed typical supplementation guidelines.

Infectious complications with nondaily versus daily infusion of intravenous fat emulsions in non-critically ill adults.

BACKGROUND: Increased risk for infection has been associated with the administration of intravenous fat emulsion (IVFE). Typically, IVFE is infused daily as part of the parenteral nutrition (PN) regimen. However, a national IVFE shortage in 2010 compelled institutions to restrict administration to nondaily. This retrospective study evaluated the rate of infections associated with the nondaily as compared to daily IVFE infusion in hospitalized adult patients. METHODS: Patients in the study group received nondaily IVFE during the shortage period, and patients in the control group received daily IVFE. The primary outcomes were the development of catheter-related bloodstream infections (CR-BSIs) or any bloodstream infection (BSI). Secondary outcomes were the development of respiratory, urinary, wound, or other infections. RESULTS: Included in the study were 52 patients, 33 patients in the study group and 19 patients in the control group. There were no CR-BSIs reported. BSIs occurred in 1 patient in the study group. The total number of infections and urinary tract infections (UTIs) per 1000 catheter days were not different between the 2 groups (45.28 vs 21.24, P = .203) and (24.39 vs 5.525, P = .099), respectively. Survival analyses showed no difference between the 2 groups for the time to first infection (11.24 vs 6.59 days, P = .30) and time to first UTI (11.97 vs 7 days, P = .093), respectively. CONCLUSIONS: Nondaily vs daily IVFE infusion did not have a significant effect on the risk of infection or time to development of infection; however, results are limited due to the small sample size. Large prospective randomized clinical trials are needed to further evaluate the effect of daily as compared to nondaily IVFE infusion on infectious complications.

Dosing and monitoring of trace elements in long-term home parenteral nutrition patients.

BACKGROUND: Trace elements (TEs) dosing and monitoring in home parenteral nutrition (PN) patients vary with their underlying conditions. METHODS: This retrospective observational study evaluated parenteral TE dosing, serum TE concentrations and monitoring, and dose-concentration relationships between TE doses and serum TE concentrations in 26 adult and adolescent home PN patients. RESULTS: There was a total of 40,493 PN days. Average parenteral zinc doses of 9.1 mg/d and 7.6 mg/d resulted in the majority of serum zinc concentrations (90%) within normal range in patients with and without short bowel syndrome (SBS), respectively. Selenium at about 70 mcg/d resulted in about 60% of serum selenium concentrations within normal range, with 38% of values below normal in patients with and without SBS alike. Copper at 1 mg/d resulted in 22.5% of serum copper concentrations above the normal range. The majority of serum manganese (94.6%) and chromium (96%) concentrations were elevated. Serum TE concentrations were infrequently monitored. Significant relationships existed between doses and serum concentrations for zinc (P < .0001), manganese (P = .012), and chromium (P < .0001) but not for selenium or copper. CONCLUSIONS: TE doses in home PN should be individualized and adjusted based on regular monitoring of TE status. In long-term home PN patients, higher zinc and selenium doses may be necessary to maintain their normal serum concentrations. Lower copper doses and restrictions of manganese and chromium supplementation may be needed to avoid their accumulation. Relationships between TE doses and serum TE concentrations vary for each TE and underlying clinical conditions.