Podcasts about parenteral

In this mini-series, we explore different health professions to get a better understanding of the variety of team members involved in patient care. In this episode, we spoke with registered dietitian and educator Kevin Pietro about his journey into the world of dietetics and the role of dietitians in healthcare. Dr. Kevin Pietro, PhD, RDN, LDN, CSSD, is an Assistant Professor and Director of Dietetics Education Programs at Loyola University Chicago.  As Program Director and SoTL-based scholar, Dr. Pietro's primary goal is to enhance dietetics education, supporting students in becoming caring, compassionate, and effective dietitians.  As an academic and Registered Dietitian Nutritionist (RDN), Dr. Pietro is committed to being an approachable, inclusive, and understanding educator.  His work as an RDN and board-certified Sports Dietitian (CSSD) has centered around nutrition education, helping hundreds of patients/clients/athletes improve their nutrition, health, and wellness. Connect with Dr. Pietro on LinkedIn: https://www.linkedin.com/in/kevin-pietro-phd-rdn-ldn-cssd-b70092b0To learn more, check out the following resources:The Academy of Nutrition and Dietetics - www.eatright.orgDietary Guidelines for Americans - www.odphp.health.gov American Society for Nutrition - www.nutrition.org American Society for Parenteral and Enteral Nutrition - www.nutritioncare.org Episode produced by: Rasa ValiaugaEpisode recording date: 2/24/25www.medicuspodcast.com | medicuspodcast@gmail.com | Donate: http://bit.ly/MedicusDonate

If mealtimes feel like a battle in your home, you're not alone. Many parents struggle with picky eating, and I've experienced it firsthand with my daughter — who, like many kids, has earned the label of a "picky eater" in our family. But how do you know when picky eating is more than just a phase? I recently heard about Pediatric Feeding Disorders (PFDs) and was shocked, confused, and intrigued by the topic. When I learned how PFDs affect millions of children, yet they often go undiagnosed or misunderstood, leaving parents feeling frustrated and helpless, I knew that I had to learn more and spread the word. That's why in this episode of Chick Chat, we sit down with Jaclyn Pederson, CEO of Feeding Matters, to break it all down for us. Who is Jaclyn Pederson? With over a decade of experience in program development, Jaclyn Pederson's broad knowledge of programming in the public and social sectors includes program and strategic initiative design, fund development, special events, grant writing, and community engagement. A system thinker and positive team builder, she uses transformational leadership principles to develop energized and efficient workgroups that influence significant organizational and systemic change for all affected by pediatric feeding disorder – such as the development of the expanded PFD Alliance. Jaclyn also manages Feeding Matters' strategic partnerships with numerous professional associations including American Speech-Language-Hearing Association (ASHA), American Society of Parenteral and Enteral Nutrition, and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). What Did We Discuss? In this episode, Jaclyn and I discussed everything about pediatric feeding disorders — from signs and symptoms to navigating and overcoming PFDs. Jaclyn also shares her expertise on when to seek help, how feeding disorders can impact a child's development, and what treatment options are available. Here are several of the questions that we covered in our conversation: What are Pediatric Feeding Disorders (PFDs)?  Can you tell us a bit about your personal experience with PFDs?  How common are PFDs?  What should families know about PFDs?  What are the signs and symptoms of PFDs that parents should be aware of?  What myths or misconceptions do you often encounter about picky eaters versus feeding disorders? How can a parent know when it's time to get their child evaluated for “picky eating”? Is there a connection between feeding disorders and developmental delays? How can parents advocate for their children when seeking help for feeding challenges? What does treatment for a PFD look like?  What advice do you have for parents feeling overwhelmed by their child's feeding challenges and looking for support? If you think your child's mealtime struggles go beyond picky eating, this episode is a must-listen. Jaclyn shares expert insights to help parents feel more confident in identifying and addressing Pediatric Feeding Disorders. Listen now, and don't forget to share this episode with a fellow parent who may need this information! Jaclyn's Resources Website: FeedingMatters.org Instagram: @feedingmatters Facebook: @feedingmatters Mentioned in the episode: Family Guide to Pediatric Feeding Disorder Thank you for listening to our podcast. Cheers to finding the best way to nourish your children! Learn more about your ad choices. Visit megaphone.fm/adchoices

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In this episode of Nutrition Pearls: the Pediatric GI Nutrition Podcast, co-hosts Bailey Koch and Nikki Misner speak with Gina O'Toole, MPH, RD, CSPCC, CLEC. Gina O'Toole received her B.S. from Seattle Pacific University in Exercise Science and Physical Education and went on to receive her Master's in Public Health and Nutrition from Loma Linda University. Gina is a Board Certified Pediatric Critical Care dietician and Certified Lactation Educator Counselor. Gina has been working in a Level IV Neonatal Intensive Care Unit (NICU) at CHOC Children's Hospital in Orange, California for almost 15 years. She has been instrumental in the institutional development of care guidelines and human milk advocacy for preterm infants, infants with short bowel syndrome/intestinal failure and those with complex surgical diagnoses. When she is not working with the babies, she loves to spend time with her husband and 3 children Lola, Brooklyn and Ellis. You will find them outdoors gardening, at the beach, camping, hiking, climbing or biking!Nutrition Pearls is supported by an educational grant from Mead Johnson Nutrition.Resources:American Society for Parenteral and Enteral Nutrition (ASPEN) - Parenteral Nutrition ResourceASPEN Pediatric Intestinal Failure Section Produced by: Corey IrwinNASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org

How are supply and demand shaping up for sterile manufacturing and aseptic fill–finish in the CDMO/CMO sector? Is a capacity crunch or capacity ease in the making? And how will hot-product areas, such as GLP-1 agonist impact market fundamentals.   Featuring Ian Tzeng, Managing Director and Partner, L.E.K. Consulting, where he focuses on healthcare and life sciences, including pharmaceuticals, vaccines, and leads L.E.K.'s Pharmaceutical Contract Services practice. Support the show

About two years ago, we released a podcast with Dr. Thomas Wadden of the University of Pennsylvania describing work on a new generation of medications to treat diabetes and obesity. They were really taking the field by storm. Since then, much more is known since many additional studies have been published and so many people have been using the drugs. So many, in fact, the market value of the Danish company, Novo Nordisk, one of the two major companies selling the drugs, has gone up. It is now greater than the entire budget of the country of Denmark. This single company is responsible for about half of Denmark's economic expansion this year. So, a lot of people are now taking the drugs and this is a great time for an update on the drugs. And we're fortunate to have two of the world's leading experts join us: Dr. Wadden, Professor of Psychology and Psychiatry at the University of Pennsylvania School of Medicine and the inaugural Albert J. Stunkard Professor of Psychiatry at Penn. Joining us as well as Dr. Robert Kushner, a physician and professor of medicine at Northwestern University and a pioneer in testing treatments for obesity. Interview Summary Tom, you and I were colleagues at Penn decades ago. And I got frustrated the treatments for obesity didn't work very well. People tended to regain the weight. And I turned my attention to prevention and policy. But you hung in there and I admired you for that patience and persistence. And Bob, the same for you. You worked on this tenacious problem for many years. But for both of you, your patience has been rewarded with what seems to me to be a seismic shift in the way obesity and diabetes can be treated. Tom, I'll begin with you. Is this as big of a deal as it seems to me? Well, I think it is as big of a deal as it seems to you. These medications have had a huge impact on improving the treatment of type 2 diabetes, but particularly the management of obesity. With older medications, patients lost about 7 percent of their starting weight. If you weighed 200 pounds, you'd lose about 15 pounds. That was also true of our best diet and exercise programs. You would lose about 7 percent on those programs with rigorous effort. But with the new medications, patients are now losing about 15 to 20 percent of their starting body weight at approximately one year. And that's a 30-to-40-pound loss for a person who started at 200 pounds. And with these larger weight losses, we get larger improvements in health in terms of complications of obesity. So, to quote a good friend of mine, Bob Kushner, these medications have been a real game changer. Thanks for putting that in perspective. I mean, we're talking about not just little incremental changes in what treatments can produce, which is what we've seen for years. But just orders of magnitude of change, which is really nice to see. So, Bob what are these medications that we're talking about? What are the names of the drugs and how do they work? Well, Kelly, this transformation of obesity really came about by finding the target that is really highly effective for obesity. It's called the gut brain axis. And when it comes to the gut it's starting off with a naturally occurring gut hormone called GLP 1. I think everyone in the country's heard of GLP 1. It's released after we eat, and it helps the pancreas produce insulin, slows the stomach release of food, and reduces appetite. And that's where the obesity story comes in. So pharmaceutical companies have taken this hormone and synthesized it, something similar to GLP 1. It mimics the action of GLP 1. So, you could actually take it and give it back and have it injected so it augments or highlights this hormonal effect. Now, that same process of mimicking a hormone is used for another gut hormone called GIP that also reduces appetite. These two hormones are the backbone of the currently available medication. There's two on the market. One is called Semaglutide. That's a GLP 1 analog. Trade name is Wegovy. Now, it's also marketed for diabetes. Tom talked about how it is used for diabetes and increases insulin. That trade name is Ozempic. That's also familiar with everyone around the country. The other one that combined GLP 1 and GIP, these two gut hormones, so it's a dual agonist, the trade name for obesity is called Zep Bound, and the same compound for diabetes is called Mounjaro. These are terms that are becoming familiar, I think, to everyone in the country. Tom mentioned some about the, how much weight people lose on these drugs, but what sort of medical changes occur? Just to reiterate what Tom said, I'll say it in another way. For Semaglutide one third of individuals are losing 20 percent of their body weight in these trials. For Tirzepatide, it even outpaces that. And I got a third of individuals losing a quarter of their body weight. These are unheard of weight losses. And with these weight losses and these independent effects from weight, what we're seeing in the trials and in the clinic is that blood pressure goes down, blood sugar goes down, blood fats like triglyceride go down, inflammation in the body goes down, because we marked that with CRP, as well as improvement in quality of life, which we'll probably get to. But really interesting stuff is coming out over the past year or two or so, that it is improving the function of people living with congestive heart failure, a particular form called a preserved ejection fraction. We're seeing improvements in sleep apnea. Think of all the people who are on these CPAP machines every night. We're seeing significant improvements in the symptoms of sleep apnea and the apneic events. And lastly, a SELECT trial came out, that's what it was called, came out last year. Which for the very first time, Kelly, found improvements in cardiovascular disease, like having a heart attack, stroke, or dying of cardiovascular disease in people living with obesity and already have cardiovascular disease. That's called secondary prevention. That, Tom, is the game changer. Bob, I'd like to go back to Tom in a minute but let me ask you one clarifying question about what you just said. That's a remarkable array of biological medical benefits from these drugs. Just incredible. And the question is, are they all attributable to the weight loss or is there something else going on? Like if somebody lost equal amounts of weight by some other means, would these same changes be occurring? Those studies are still going on. It's very good. We're thinking it's a dual effect. It's the profound amount of weight loss, as Tom said. Fifteen to 21 to even 25 percent of average body weight. That is driving a lot of the benefits. But there also appear to be additional effects or weight independent effects that are working outside of that weight. We're seeing improvements in kidney function, improvement in heart disease, blood clotting, inflammation. And those are likely due to the gut hormone effect independent of the weight itself. That still needs to be sorted out. That's called a mitigation analysis where we try to separate out the effects of these drugs. And that work is still underway. Tom, one of the most vexing problems, over the decades that people have been working on treatments for obesity, has been long term results. And I'm curious about how long have people been followed on these drugs now? What are the results? And what was the picture before then? How do what we see now compared to what you saw before? The study that Bob just mentioned, the SELECT trial followed people for four years on Semaglutide. And patients achieve their maximal weight loss at about one year and they lost 10 percent of their weight. And when they were followed up at four years still on treatment, they still maintained a 10 percent weight loss. That 10 percent is smaller than in most of the trials, where it was a 15 percent loss. But Dr. Tim Garvey showed that his patients in a smaller trial lost about 15 percent at one year and while still on medication kept off the full 15 percent. I think part of the reason the weight loss in SELECT were smaller is because the study enrolled a lot of men. Men are losing less weight on this medication than women. But to your question about how these results compare to the results of earlier treatment, well with behavioral treatment, diet, and exercise back in the 70s beyond, people lost this 7 or 8 percent of weight. And then most people on average regain their weight over one to three years. And the same was true of medication. People often stopped these earlier medications after 6 to 12 months, in part because they're frustrated the losses weren't larger. Some people were also worried about the side effects. But the long and short is once you stop taking the medication, people would tend to regain their weight. And some of this weight regain may be attributable to people returning to their prior eating and activity habits. But one of the things we've learned over the past 20 years is that part of the weight regain seems to be attributable to changes in the body's metabolism. And you know that when you lose weight, you're resting metabolic rate, which is the number of calories your body burns at rest to maintain basic bodily functions. Your resting metabolic rate decreases by 10 to 15 percent. But also, your energy expenditure, the calories you burn during exercise decreases. And that may decrease by as much as 20 to 30 percent. So, people are left having to really watch their calories very carefully because of their lower calorie requirements in order to keep off their lost body weight. I think one thing these new drugs may do is to attenuate the drop both in resting metabolic rate and energy expenditure during physical activity. But the long and short of it is that if you stay on these new medications long term, you'll keep off your body weight. And you'll probably keep it off primarily because of improvements in your appetite, so you have less hunger. And as a result, you're eating less food. I'd like to come back to that in a minute. But let me ask a question. If a person loses weight, and then their body starts putting biological pressure on them to regain, how come? You know, it's disadvantageous for their survival and their health to have the excess weight. Why would the body do that? Well, our bodies evolved in an environment of food scarcity, and our physiology evolved to protect us against starvation. First, by allowing us to store body fat, a source of energy when food is not available. And second, the body's capacity to lower its metabolism, or the rate at which calories are burned to maintain these basic functions like body temperature and heart rate. That provided protection against food scarcity. But Kelly, you have described better than anybody else that these ancient genes that regulate energy expenditure and metabolism are now a terrible mismatch for an environment in which food is plentiful, high in calories, and available 24 by 7. The body evolved to protect us from starvation, but not from eating past our calorie needs. And so, it's this mismatch between our evolution and our appetite and our body regulation in the current, what you have called toxic food environment, when you can eat just all the time. I guess you could think about humans evolving over thousands of years and biology adapting to circumstances where food was uncertain and unpredictable. But this modern environment has happened really pretty rapidly and maybe evolution just hasn't had a chance to catch up. We're still existing with those ancient genes that are disadvantageous in this kind of environment. Bob back to the drugs. What are the side effects of the drugs? Kelly, they're primarily gastrointestinal. These are symptoms like nausea, diarrhea, constipation, heartburn, and vomiting. Not great, but they're generally considered mild to moderate, and temporary. And they primarily occur early during the first four to five months when the medications are slowly dose escalated. And we've learned, most importantly, how to mitigate or reduce those side effects to help people stay on the drug. Examples would be your prescriber would slow the dose escalation. So. if you're having some nausea at a particular dose, we wait another month or two. The other, very importantly, is we have found that diet significantly impacts these side effects. When we counsel patients on these medications, along with that comes recommendations for dietary changes, such as reducing fatty food and greasy food. Reducing the amount of food you're consuming. Planning your meals in advance. Keeping well hydrated. And very importantly, do not go out for a celebration or go out to meals on the day that you inject or at least the first two days. Because you're not going to tolerate the drug very well. We use that therapeutically. So, if you want to get control on the weekends, you may want to take your injection on a Friday. However, if weekends are your time out with friends and you want to socialize, don't take it on a Friday. Same thing comes with a personal trainer, by the way. If you're going to have a personal trainer on a Monday where he's going to overwork you, don't take the injection the day before. You'll likely be nauseated, you're not eating, you're not hydrating. So actually, there's a lot that goes into not only when to take the dose and how to take the dose, but how to take it to the best ability to tolerate it. Two questions based on what you said. One is you talked about these are possible side effects, but how common are they? I mean, how many people suffer from these? Well, the trials show about 25 to 45 percent or so of individuals actually say they have these symptoms. And again, we ask them mild, moderate, severe. Most of them are mild to moderate. Some of them linger. However, they really do peak during the dose escalation. So, working with your prescriber during that period of time closely, keeping contact with them on how to reduce those side effects and how you're doing out of medication is extremely important. And the second thing I wanted to ask related to that is I've heard that there's a rare but serious potential side effect around the issue of stomach paralysis. Can you tell us something about that? I mentioned earlier, Kelly, that these medications slow gastric emptying. That's pretty much in everybody. In some individuals who may be predisposed to this, they develop something called ileus, and that's the medical term for gastric paralysis. And that can happen in individuals, let's say who have a scleroderma, who have longstanding diabetes or other gastrointestinal problems where the stomach really stopped peristalsis. In other words, it's moving. That's typically presented by vomiting and really unable to move the food along. We really haven't seen much of that. We looked at the safety data in a SELECT trial that Tom mentioned, which was 17,000 individuals, about 8,000 or so in each group. We really did not see a significant increase in the ileus or what you're talking about in that patient population. Okay, thanks. Tom had alluded to this before, Bob, but I wanted to ask you. How do you think about these medicines? If somebody takes them, and then they stop using the medicines and they gain the weight back. Is that a sign that the medicine works or doesn't work? And is this the kind of a chronic use drug like you might take for blood pressure or cholesterol? That's a great way of setting up for that. And I like to frame it thinking of it as a chronic progressive disease, just like diabetes or hypertension. We know that when you have those conditions, asthma could be another one or inflammatory bowel disease, where you really take a medication long term to keep the disease or condition under control. And we are currently thinking of obesity as a chronic disease with dysfunctional appetite and fat that is deposited in other organs, causing medical problems and so on. If you think of it as a chronic disease, you would naturally start thinking of it, like others, that medication is used long term. However, obesity appeared to be different. And working with patients, they still have this sense 'that's my fault, I know I can do it, I don't want to be on medication for the rest of my life for this.' So, we have our work cut out for us. One thing I can say from the trials, and Tom knows this because he was involved in them. If we suddenly stop the medication, that's how these trials were definitely done, either blindly or not blindly, you suddenly stop the medication, most, if not all of the participants in these trials start to regain weight. However, in a clinical practice, that is not how we work. We don't stop medication suddenly with patients. We go slowly. We down dose the medication. We may change to another medication. We may use intermittent therapy. So that is work that's currently under development. We don't know exactly how to counsel patients regarding long term use of the medications. I think we need to double down on lifestyle modification and counseling that I'm sure Tom is going to get into. This is really work ahead of us, how to maintain medication, who needs to be on it long term, and how do we actually manage patients. Tom, you're the leading expert in the world on lifestyle change in the context of obesity management. I mean, thinking about what people do with their diet, their physical activity, what kind of thinking they have related to the weight loss. And you talked about that just a moment ago. Why can't one just count on the drugs to do their magic and not have to worry about these things? Well, first, I think you can count on the drugs to do a large part of the magic. And you may be surprised to hear me say that. But with our former behavioral treatments of diet and exercise, we spent a lot of time trying to help people identify how many calories they were consuming. And they did that by recording their food intake either in paper and pencil or with an app. And the whole focus of treatment was trying to help people achieve a 500 calorie a day deficit. That took a lot of work. These medications, just by virtue of turning down your appetite and turning down your responsiveness to the food environment, take away the need for a lot of that work, which is a real blessing. But the question that comes up is, okay, people are eating less food. But what are they eating? Do these medications help you eat a healthier diet with more fruits and vegetables, with lean protein? Do you migrate from a high fat, high sugar diet to a Mediterranean diet, or to a DASH like diet? And the answer is, we don't know. But obviously you would like people to migrate to a diet that's going to be healthier for you from a cardiovascular standpoint, from a cancer risk reduction standpoint. One of the principal things that people need to do on these medications is to make sure they get plenty of protein. And so, guidance is that you should have about 1 gram of dietary protein for every kilogram of body weight. If you're somebody who weighs 100 kilograms, you should get 100 grams of protein. And what you're doing is giving people a lot of dietary protein to prevent the loss of bodily protein during rapid weight loss. You did a [00:20:00] lot of research with me back in the 80s on very low-calorie diets, and that was the underpinning of treatment. Give people a lot of dietary protein, prevent the loss of bodily protein. The other side of the equation is just physical activity, and it's a very good question about whether these medications and the weight loss they induce will help people be more physically active. I think that they will. Nonetheless for most people, you need to plan an activity schedule where you adopt new activities, whether it's walking more or going to the gym. And one thing that could be particularly helpful is strength training, because strength training could mitigate some of the loss of muscle mass, which is likely to occur with these medications. So, there's still plenty to learn about what is the optimal lifestyle program, but I think people, if they want to be at optimal health will increase their physical activity and eat a diet of fruits and vegetables, leaner protein, and less ultra processed foods. Well, isn't it true that eating a healthy diet and being physically active have benefits beyond their impact on your ability to lose the weight? You're getting kind of this wonderful double benefit, aren't you? I believe that is true. I think you're going to find that there are independent benefits of being physical activity upon your cardiovascular health. There are independent benefits of the food that you're eating in terms of reducing the risk of heart attack and of cancer, which has become such a hot topic. So, yes how you exercise and what you eat makes a difference, even if you're losing weight. Well, plus there's probably the triple one, if you will, from the psychological benefit of doing those things, that you do those things, you feel virtuous, that helps you adhere better as you go forward, and these things all come together in a nice picture when they're working. Tom, let's talk more about the psychology of these things. You being a psychologist, you've spent a lot of time doing research on this topic. And of course, you've got a lot of clinical experience with people. So as people are losing weight and using these drugs, what do they experience? And I'm thinking particularly about a study you published recently, and Bob was a coauthor on that study that addressed mental health outcomes. What do people experience and what did you find in that study? I think the first things people experience is improvements in their physical function. That you do find as you've lost weight that you've got less pain in your knees, you've got more energy, it's easier to get up the stairs, it's easier to play with the children or the grandchildren. That goes a long way toward making people feel better in terms of their self-efficacy, their agency in the life. Big, big improvement there. And then, unquestionably, people when they're losing a lot of weight tend to feel better about their appearance in some cases. They're happy that they can buy what they consider to be more fashionable clothes. They get compliments from friends. So, all of those things are positive. I'm not sure that weight loss is going to change your personality per se, or change your temperament, but it is going to give you these physical benefits and some psychological benefits with it. We were happy to find in the study you mentioned that was conducted with Bob that when people are taking these medications, they don't appear to be at an increased risk of developing symptoms of depression or symptoms of suicidal ideation. There were some initial reports of concern about that, but the analysis of the randomized trials that we conducted on Semaglutide show that there is no greater likelihood of developing depression or sadness or suicidal ideation on the medication versus the placebo. And then the FDA and the European Medicines Agency have done a full review of all post marketing reports. So, reports coming from doctors and the experience with their patients. And in looking at those data the FDA and the European Medicines Agency have said, we don't find a causal link between these medications and suicidal ideation. With that said, it's still important that if you're somebody who's taking these medications and you start them, and all of a sudden you do feel depressed, or all of a sudden you do have thoughts like, maybe I'd be better off if I weren't alive any longer, you need to talk to your primary care doctor immediately. Because it is always possible somebody's having an idiosyncratic reaction to these medications. It's just as possible the person would have that reaction without being on a medication. You know, that, that can happen. People with overweight and obesity are at higher risk of depression and anxiety disorders. So, it's always going to be hard to tease apart what are the effects of a new medication versus what are just the effects of weight, excess weight, on your mood and wellbeing. You know, you made me think of something as you were just speaking. Some people may experience negative effects during weight loss, but overall, the effects are highly positive and people are feeling good about themselves. They're able to do more things. They fit in better clothes. They're getting good feedback from their environment and people they know. And then, of course, there's all the medical benefit that makes people feel better, both psychologically and physically. Yet there's still such a strong tendency for people to regain weight after they've lost. And it just reinforces the fact that, the point that you made earlier, that there are biological processes at work that govern weight and tendency to regain. And there really is no shame in taking the drug. I mean, if you have high blood pressure, there's no shame in taking the drug. Or high cholesterol or anything else, because there's a biological process going on that puts you at risk. The same thing occurs here, so I hope the de-shaming, obesity in the first place, and diabetes, of course, and then the use of these medications in particular might help more people get the benefits that is available for them. I recommend that people think about their weight as a biologically regulated event. Very much like your body temperature is a biologically regulated event, as is your blood pressure and your heart rate. And I will ask people to realize that there are genetic contributors to your body weight. just as there are to your height. If somebody says, I just feel so bad about being overweight I'll just talk with them about their family history of weight and see that it runs in the family. Then I'll talk to them about their height. Do you feel bad about being six feet tall, to a male? No, that's fine. Well, that that's not based upon your willpower. That's based upon your genes, which you received. And so, your weight, it's similarly based. And if we can use medications to help control weight, cholesterol, blood pressure, blood sugar, let's do that. It's just we live in a time where we're fortunate to have the ability to add medications to help people control health complications including weight. Bob, there are several of the drugs available. How does one think about picking between them? Well, you know, in an ideal medical encounter, the prescriber is going to take into consideration all the factors of prescribing a medication, like any other medication, diabetes, hypertension, you name the condition. Those are things like contraindication to use. What other medical problems does the patient have that may benefit the patient. Patient preferences, of course and side effects, safety, allergies, and then we have cost. And I'll tell you, Kelly, because of our current environment, it's this last factor, cost, that's the most dominant factor when it comes to prescribing medication. I'll have a patient walk in my room, I'll look at the electronic medical record, body mass index, medical problems. I already know in my head what is going to be the most effective medication. That's what we're talking about today. Unfortunately, I then look at the patient insurance, which is also on the electronic medical record, and I see something like Medicaid or Medicare. I already know that it's not going to be covered. It is really quite unfortunate but ideally all these factors go into consideration. Patients often come in and say, I've heard about Ozempic am I a candidate for it, when can I get it? And unfortunately, it's not that simple, of course. And those are types of decisions the prescriber goes through in order to come to a decision, called shared decision making with the patient. Bob, when I asked you the initial question about these drugs, you were mentioning the trade name drugs like Mounjaro and Ozempic and those are made by basically two big pharmaceutical companies, Novo Nordisk and Eli Lilly. But there are compounded versions of these that have hit the scene. Can you explain what that means and what are your thoughts about the use of those medications? So compounding is actually pretty commonly done. It's been approved by the FDA for quite some time. I think most people are familiar with the idea of compounding pharmacies when you have a child that must take a tablet in a liquid form. The pharmacy may compound it to adapt to the child. Or you have an allergy to an ingredient so the pharmacy will compound that same active ingredient so you can take it safely. It's been approved for long periods of time. Anytime a drug is deemed in shortage by the FDA, but in high need by the public, compounding of that trade drug is allowed. And that's exactly what happened with both Semaglutide and Tirzepatide. And of course, that led to this compounding frenzy across the country with telehealth partnering up with different compounding pharmacies. It's basically making this active ingredient. They get a recipe elsewhere, they don't get it from the company, they get this recipe and then they make the drug or compound it themselves, and then they can sell it at a lower cost. I think it's been helpful for people to get the drug at a lower cost. However, buyer beware, because not all compounded pharmacies are the same. The FDA does not closely regulate these compounded pharmacies regarding quality assurance, best practice, and so forth. You have to know where that drug is coming from. Kelly, it's worth noting that just last week, ZepBound and Mounjaro came off the shortage list. You no longer can compound that and I just read in the New York Times today or yesterday that the industry that supports compounding pharmacies is suing the FDA to allow them to continue to compound it. I'm not sure where that's going to go. I mean, Eli Lilly has made this drug. However, Wegovy still is in shortage and that one is still allowed to be compounded. Let's talk a little bit more about costs because this is such a big determinant of whether people use the drugs or not. Bob, you mentioned the high cost, but Tom, how much do the drugs cost and is there any way of predicting what Bob just mentioned with the FDA? If the compounded versions can't be used because there's no longer a shortage, will that decrease pressure on the companies to keep the main drug less expensive. I mean, how do you think that'll all work out? But I guess my main question is how much these things cost and what's covered by insurance? Well first how much do the drugs cost? They cost too much. Semaglutide, known in retail as Wegovy, is $1,300 a month if you do not have insurance that covers it. I believe that Tirzepatide, known as ZepBound, is about $1,000 a month if you don't have insurance that covers that. Both these drugs sometimes have coupons that bring the price down. But still, if you're going to be looking at out of pocket costs of $600 or $700 or $800 a month. Very few people can afford that. The people who most need these medications are people often who are coming from lower incomes. So, in terms of just the future of having these medications be affordable to people, I would hope we're going to see that insurance companies are going to cover them more frequently. I'm really waiting to see if Medicare is going to set the example and say, yes, we will cover these medications for anybody with a BMI of 40 or a BMI of 35 with comorbidities. At this point, Medicare says, we will only pay for this drug if you have a history of heart attack and stroke, because we know the drug is going to improve your life expectancy. But if you don't have that history, you don't qualify. I hope we'll see that. Medicaid actually does cover these medications in some states. It's a state-by-state variation. Short of that, I think we're going to have to have studies showing that people are on these medications for a long time, I mean, three to five years probably will be the window, that they do have a reduction in the expenses for other health expenditures. And as a result, insurers will see, yes, it makes sense to treat excess weight because I can save on the cost of type 2 diabetes or sleep apnea and the like. Some early studies I think that you brought to my attention say the drugs are not cost neutral in the short-term basis of one to two years. I think you're going to have to look longer term. Then I think that there should be competition in the marketplace. As more drugs come online, the drug prices should come down because more will be available. There'll be greater production. Semaglutide, the first drug was $1,300. Zepbound, the second drug Tirzepatide, $1,000. Maybe the third drug will be $800. Maybe the fourth will be $500. And they'll put pressure on each other. But I don't know that to be a fact. That's just my hope. Neither of you as an economist or, nor do you work with the companies that we're talking about. But you mentioned that the high cost puts them out of reach for almost everybody. Why does it make sense for the companies to charge so much then? I mean, wouldn't it make sense to cut the price in half or by two thirds? And then so many more people would use them that the company would up ahead in the long run. Explain that to me. That's what you would think, for sure. And I think that what's happened right now is that is a shortage of these drugs. They cannot produce enough of them. Part of that is the manufacturing of the injector pens that are used to dispense the drug to yourself. I know that Novo Nordisk is building more factories to address this. I assume that Lilly will do the same thing. I hope that over time we will have a larger supply that will allow more people to get on the medication and I hope that the price would come down. Of course, in the U. S. we pay the highest drug prices in the world. Fortunately, given some of the legislation passed, Medicare will be able to negotiate the prices of some of these drugs now. And I think they will negotiate on these drugs, and that would bring prices down across the board. Boy, you know, the companies have to make some pretty interesting decisions, don't they? Because you've alluded to the fact that there are new drugs coming down the road. I'm assuming some of those might be developed and made by companies other than the two that we're talking about. So, so investing in a whole new plant to make more of these things when you've got these competitor drugs coming down the road are some interesting business issues. And that's not really the topic of what we're going to talk about, but it leads to my final question that I wanted to ask both of you. What do you think the future will bring? And what do you see in terms of the pipeline? What will people be doing a year from now or 2 or 5? And, you know, it's hard to have a crystal ball with this, but you two have been, you know, really pioneers and experts on this for many years. You better than anybody probably can answer this question. Bob, let me start with you. What do you think the future will bring? Well, Kelly, I previously mentioned that we finally have this new therapeutic target called the gut brain axis that we didn't know about. And that has really ushered in a whole new range of potential medications. And we're really only at the beginning of this transformation. So not only do we have this GLP 1 and GIP, we have other gut hormones that are also effective not only for weight loss, but other beneficial effects in the body, which will become household names, probably called amylin and glucagon that joins GLP 1. And we not only have these monotherapies like GLP 1 alone, we are now getting triagonists. So, we've got GIP, GLP 1, and glucagon together, which is even amplifying the effect even further. We are also developing oral forms of GLP 1 that in the future you could presumably take a tablet once a day, which will also help bring the cost down significantly and make it more available for individuals. We also have a new generation of medications being developed which is muscle sparing. Tom talked about the importance of being strong and physical function. And with the loss of lean body mass, which occurs with any time you lose weight, you can also lose muscle mass. There's drugs that are also going in that direction. But lastly, let me mention, Kelly, I spend a lot of my time in education. I think the exciting breakthroughs will not be meaningful to the patient unless the professional, the provider and the patient are able to have a nonjudgmental informative discussion during the encounter without stigma, without bias. Talk about the continuum of care available for you, someone living with obesity, and get the medications to the patient. Without that, medications over really sit on the shelf. And we have a lot of more work to do in that area. You know, among the many reasons I admire the both of you is that you've, you've paid a lot of attention to that issue that you just mentioned. You know, what it's like to live with obesity and what people are experiencing and how the stigma and the discrimination can just have devastating consequences. The fact that you're sensitive to those issues and that you're pushing to de-stigmatize these conditions among the general public, but also health care professionals, is really going to be a valuable advance. Thank you for that sensitivity. Tom, what do you think? If you appear into the crystal ball? What does it look like? I would have to agree with Bob that we're going to have so many different medications that we will be able to combine together that we're going to see that it's more than possible to achieve weight losses of 25 to 30 percent of initial body weight. Which is just astonishing to think that pharmaceuticals will be able to achieve what you achieve now with bariatric surgery. I think that it's just, just an extraordinary development. Just so pleased to be able to participate in the development of these drugs at this stage of career. I still see a concern, though, about the stigmatization of weight loss medications. I think we're going to need an enormous dose of medical education to help doctors realize that obesity is a disease. It's a different disease than some of the illnesses that you treat because, yes, it is so influenced by the environment. And if we could change the environment, as you've argued so eloquently, we could control a lot of the cases of overweight and obesity. But we've been unable to control the environment. Now we're taking a course that we have medications to control it. And so, let's use those medications just as we use medications to treat diabetes. We could control diabetes if the food environment was better. A lot of medical education to get doctors on board to say, yes, this is a disease that deserves to be treated with medication they will share that with their patients. They will reassure their patients that the drugs are safe. And that they're going to be safe long term for you to take. And then I hope that society as a whole will pick up that message that, yes, obesity and overweight are diseases that deserve to be treated the same way we treat other chronic illnesses. That's a tall order, but I think we're moving in that direction. BIOS Robert Kushner is Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine, and Director of the Center for Lifestyle Medicine in Chicago, IL, USA. After finishing a residency in Internal Medicine at Northwestern University, he went on to complete a post-graduate fellowship in Clinical Nutrition and earned a Master's degree in Clinical Nutrition and Nutritional Biology from the University of Chicago. Dr. Kushner is past-President of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), the American Board of Physician Nutrition Specialists (ABPNS), past-Chair of the American Board of Obesity Medicine (ABOM), and Co-Editor of Current Obesity Reports. He was awarded the ‘2016 Clinician-of-the-Year Award' by The Obesity Society and John X. Thomas Best Teachers of Feinberg Award at Northwestern University Feinberg School of Medicine in 2017. Dr. Kushner has authored over 250 original articles, reviews, books and book chapters covering medical nutrition, medical nutrition education, and obesity, and is an internationally recognized expert on the care of patients who are overweight or obese. He is author/editor of multiple books including Dr. Kushner's Personality Type Diet (St. Martin's Griffin Press, 2003; iuniverse, 2008), Fitness Unleashed (Three Rivers Press, 2006), Counseling Overweight Adults: The Lifestyle Patterns Approach and Tool Kit (Academy of Nutrition and Dietetics, 2009) and editor of the American Medical Association's (AMA) Assessment and Management of Adult Obesity: A Primer for Physicians (2003). Current books include Practical Manual of Clinical Obesity (Wiley-Blackwell, 2013), Treatment of the Obese Patient, 2nd Edition (Springer, 2014), Nutrition and Bariatric Surgery (CRC Press, 2015), Lifestyle Medicine: A Manual for Clinical Practice (Springer, 2016), and Obesity Medicine, Medical Clinics of North America (Elsevier, 2018). He is author of the upcoming book, Six Factors to Fit: Weight Loss that Works for You! (Academy of Nutrition and Dietetics, December, 2019). Thomas A. Wadden is a clinical psychologist and educator who is known for his research on the treatment of obesity by methods that include lifestyle modification, pharmacotherapy, and bariatric surgery. He is the Albert J. Stunkard Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and former director of the university's Center for Weight and Eating Disorders. He also is visiting professor of psychology at Haverford College. Wadden has published more than 550 peer-reviewed scientific papers and abstracts, as well as 7 edited books. Over the course of his career, he has served on expert panels for the National Institutes of Health, the Federal Trade Commission, the Department of Veterans Affairs, and the U.S. House of Representatives. His research has been recognized by awards from several organizations including the Association for the Advancement of Behavior Therapy and The Obesity Society. Wadden is a fellow of the Academy of Behavioral Medicine Research, the College of Physicians of Philadelphia, the Obesity Society, and Society of Behavioral Medicine. In 2015, the Obesity Society created the Thomas A. Wadden Award for Distinguished Mentorship, recognizing his education of scientists and practitioners in the field of obesity.

Earn 0.1 ASHA CEU for this episode with Speech Therapy PD: www.speechtherapypd.com/course?name=Feeding-Matters-Leading-the-Way-for-ARFID-and-PFDIn the first episode of 2025, Michelle is joined by Jaclyn Pederson, MHI, CEO of Feeding Matters, and William Sharp, PhD, Director of Children's Multidisciplinary Feeding Program (Atlanta, GA) and Professor at Emory University School of Medicine, to lay the foundation for a year of combining passion, advocacy, and learning. These guests share their expertise and highlights from a recent journal publication on how the diagnoses of “Pediatric Feeding Disorder” and “Avoidant Restrictive Feeding Intake Disorder” are individualistic while simultaneously overlapping to capture the unique needs of the little ones on our caseloads. Additionally, they share practical insight into the roles and responsibilities of various team members, such as the SLP and the psychologist, in evaluating and treating these little ones as part of an interprofessional practice team.About the Guests: Jaclyn Peterson, MHI: With more than a decade of experience in program development, Jaclyn Pederson's broad knowledge of programming in the public and social sectors includes program and strategic initiative design, fund development, special events, grant writing, and community engagement. A system thinker and positive team builder, she uses transformational leadership principles to develop energized and efficient workgroups that influence significant organizational and systemic change for all affected by pediatric feeding disorder –such as the development of the expanded PFD Alliance. Jaclyn also manages Feeding Matters' strategic partnerships with numerous professional associations, including the American Speech-Language-Hearing Association (ASHA), the American Society of Parenteral and Enteral Nutrition, and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).William Sharp, PhD is a clinical psychologist and professor in the department of pediatrics at Emory University School of Medicine. He is also the Director of Children's Healthcare of Atlanta's Multidisciplinary Feeding Program. In this role, Dr. Sharp leads a team of professionals that includes psychologists, physicians, speech-language pathologists, and dietitians who evaluate and treat children with pediatric feeding disorder and avoidant restrictive food intake disorder (ARFID). His research interest focuses on identifying the cause, consequences, and treatment of chronic food refusal in pediatric populations. His most recent work involves developing and evaluating a training curriculum for therapists to deliver a manual-based intervention for food selectivity - or extremely narrow dietary in children with ARFID.Hosted by: Michelle Dawson MS, CCC-SLP, CLC, BCS-SWatch the full video interview on YouTube: https://www.youtube.com/@speechtherapypd

In this episode of Nutrition Pearls: the Podcast, co-hosts Bailey Koch and Nikki Misner speak with Rashelle Berry on nasogastric feeding tube placement and weaning enteral nutrition. Rashelle has been working at Children's Healthcare of Atlanta for over 16 years as a dietitian in the Marcus Autism Center's feeding program. She previously served as the nutrition manager of the intensive feeding program. Currently, Rashelle's clinical work is focused on infants and children with pediatric feeding disorders in both the outpatient clinical and rehab settings. She is especially passionate about weaning children from tube feedings. Rashelle also serves on the Georgia Board of Examiners for Licensed Dietitians and as a site reviewer for the Accreditation Council for Education in Nutrition and Dietetics.Nutrition Pearls is supported by an educational grant from Reckitt Mead Johnson Nutrition.Resources:Academy Quality Management Committee. Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist. J Acad Nutr Diet. 2018;118(1):141-165. doi:10.1016/j.jand.2017.10.002Corrigan ML, Bobo E, Rollins C, Mogensen KM. Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support. Nutr Clin Pract. 2021;36(6):1126-1143. doi:10.1002/ncp.10774Produced by: Corey IrwinNASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org

No episódio dessa semana, recebemos Elieth Padovani, nutricionista e Especialista em Nutrição Enteral e Parenteral. Professora adjunta do curso de Nutrição e Farmácia da UNIPAC de Juiz de Fora, ministra aulas e palestras na área de saúde, nutrição em oncologia e atua em consultório com ênfase em nutrição esportiva funcional. Elieth fala sobre essa tendência de dar tanta importância ao consumo de proteínas, pontuando se Isso sempre existiu ou é algo mais recente. Além disso, compartilha conosco sobre a existência ou não de riscos ao consumir uma quantidade maior do que a recomendada de proteínas. E também pontua sobre a associação de quantidade de proteína com consumo de carne, citando algumas fontes vegetais de proteína. Ela dá dicas para pessoas que seguem dietas veganas e vegetarianas atingirem a quantidade recomendada de proteínas.

Damos por sentadas muchas cosas, y la capacidad de alimentarnos por vía oral es una de ellas. Sin embargo, enfermedades o accidentes pueden ser dos de las principales razones que limitan este acto y nos llevan a necesitar soporte nutricional a través de sondas. Este tipo de nutrición merece un espacio en Ser Nutritivo Podcast, porque concientizar sobre su existencia y la importancia de su correcta utilización puede salvar muchas vidas en situaciones donde comer ya no es una opción. Hablemos de nutrición enteral y parenteral junto a Judith Soto.

In this episode of Dietitians Only, we're recapping some nutrition best practice recommendations that are frequently forgotten or overlooked. Tune in to hear seasoned dietitian, Amy Hurd, RD, LDN debunk some myths surrounding gastric residual volumes, albumin, glucose control, and micronutrient supplementation.  References:  “Vitamin A and Carotenoids - Health Professional Fact Sheet.” Office of Dietary Supplements (ODS), https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/. Accessed 13 Mar. 2024.  “Vitamin C - Health Professional Fact Sheet.” Office of Dietary Supplements (ODS), https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/. Accessed 13 Mar. 2024.  Older Adults: Standards of Medical Care in Diabetes—2019 | Diabetes Care | American Diabetes Association (diabetesjournals.org)  (2019), Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. Journal  of Parenteral and Enteral Nutrition, 43: S1-S3. https://doi.org/10.1002/jpen.1517  “Zinc - Health Professional Fact Sheet.” Office of Dietary Supplements (ODS), https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/. Accessed 13 Mar. 2024.  Maxfield, Luke. “Zinc Deficiency - StatPearls - NCBI Bookshelf.” National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/books/NBK493231/. Accessed 13 Mar. 2024.  Murphree J, Mulherin DW, Morton C, Adams D. High-dose vitamin C therapy for symptomatic deficiency in a patient with myasthenia gravis and Crohn's disease. Nutr Clin Pract. 2022; 37: 1242-1245. https://doi.org/10.1002/ncp.10800  McClave, Stephen, MD, Beth Taylor, D, DCN, and Robert Martindale, MD, PhD. "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)." Journal of Parenteral and Enteral Nutrition 40.#2 (2016): 159-211.   Boullata, J.I., Carrera, A.L., Harvey, L., Escuro, A.A., Hudson, L., Mays, A., McGinnis, C., Wessel, J.J., Bajpai, S., Beebe, M.L., Kinn, T.J., Klang, M.G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P. and (2017), ASPEN Safe Practices for Enteral Nutrition Therapy. Journal of Parenteral and Enteral Nutrition, 41: 15-103 0148607116673053. https://doi.org/10.1177/0148607116673053  Bechtold ML, Brown PM, Escuro A, et al. When is enteral nutrition indicated? J Parenter Enteral Nutr. 2022; 46: 1470-1496. doi:10.1002/jpen.2364 

Welcome to The Peds NP Acute Care Faculty series! This series was created and peer-edited by national leaders in acute care PNP education collaborating with one another to meet the needs of our future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.    *This is the second episode in a 2 part series on enteral feeding. Listen to Episode 75: Malnutrition and Feeding Tube Selection first.   This episode walks through the decision-making for which enteral formula to select based on the patient's age, protein needs, and GI function. A list of commercially available examples is listed for each age group and protein type. Fluid and caloric goals are discussed to determine if concentrated formulas are appropriate. Lastly, the process of starting continuous feeds and advancing to bolus feeds while assessing for tolerance is reviewed. Build functional skills by following along with a case study that is continued from the prior episode. It's proof that there's more than just formula that goes into tube feedings.   Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC   References: Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364 Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642 Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654 Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children's. Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134 Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533 Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12

Welcome back to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside.    This episode begins with a brief review of malnutrition and pediatric nutritional assessment in acute care settings. Next we begin a choose-your-own-nutrition adventure by asking a series of questions that aid in medical decision-making for which nutrition route is appropriate, and, if enteral feeding is best, then determines the type of tube indicated. A case-based discussion with examples helps you to apply the concepts to a complex scenario. Our next episode will focus on formula selection, the initiation of feeds, and assessment of tolerance.   Authors: Becky Carson, DNP, APRN, CPNP-PC/AC, Jessica D. Murphy, DNP, CPNP-AC, CPHON, CNE, & Marian Malone, DNP, APRN, CPNP-AC/PC   References: Bechtold, M. L., Brown, P. M., Escuro, A., Grenda, B., Johnston, T., Kozeniecki, M., Limketkai, B. N., Nelson, K. K., Powers, J., Ronan, A., Schober, N., Strang, B. J., Swartz, C., Turner, J., Tweel, L., Walker, R., Epp, L., & Malone, A. (2022). When is enteral nutrition indicated? Journal of Parenteral and Enteral Nutrition, 46(7), 1470–1496. https://doi.org/10.1002/jpen.2364 Becker, P., Carney, L. N., Corkins, M. R., Monczka, J., Smith, E., Smith, S. E., Spear, B. A., & White, J. V. (2014). Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutrition in Clinical Practice, 30(1), 147–161. https://doi.org/10.1177/0884533614557642 Green Corkins, K. (2015). Nutrition‐focused physical examination in pediatric patients. Nutrition in Clinical Practice, 30(2), 203–209. https://doi.org/10.1177/0884533615572654 Hess, L., & Crossen, J. (2008). Pediatric Nutrition Handbook (3rd ed.). Cincinnati Children's.  Mehta, N. M., Skillman, H. E., Irving, S. Y., Coss-Bu, J. A., Vermilyea, S., Farrington, E. A., McKeever, L., Hall, A. M., Goday, P. S., & Braunschweig, C. (2017). Guidelines for the provision and assessment of Nutrition Support Therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Pediatric Critical Care Medicine, 18(7), 675–715. https://doi.org/10.1097/pcc.0000000000001134 Panchal, A. K., Manzi, J., Connolly, S., Christensen, M., Wakeham, M., Goday, P. S., & Mikhailov, T. A. (2014). Safety of enteral feedings in critically ill children receiving vasoactive agents. Journal of Parenteral and Enteral Nutrition, 40(2), 236–241. https://doi.org/10.1177/0148607114546533 Yi, Dae Young. (2018). Enteral nutrition in pediatric patients. Pediatric Gastroenterology, Hepatology & Nutrition, 21(1), 12-19. http://doi.org/10.5223/pghn.2018.21.1.12

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health. His remarks ended at the 2 minute: 24 second mark. Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders. Part 1 Dr. Kaelin described the interesting relationship between the University of Louisville Frazier Rehabilitation Institute and NYU Rusk in New York. The Institute has its origins at NYU. His presentation had a focus on cellular level and pathophysiology that contribute to complications of brain injury, Alzheimer's type dementia, Parkinson's Disease and some similarities that exist. He began a literature review one-year ago on this topic, which has led to today's discussion. It is important to start by talking a little about the pathophysiology TBI and cerebral insults. It can have some correlation to stroke and other insults to the brain and central nervous system. He also talked a little bit about things that we don't think about much as physiatrists –astrocytes and microglia and what their roles are in the brain and in brain trauma. He indicated that astrocytes are the scaffolding or the structure upon which neurons and other cells hold themselves to and create the structure and shape of the brain. Microglial cells help in brain infection and brain inflammation. In a resting, healthy brain they are highly mobile and will undergo morphological changes following a brain trauma. He indicated that synapses between neurons are significantly affected both mechanically and in becoming lost in severe brain injury. He discussed the importance of sleep for patients with a brain injury. Part 2 Repetitive mild brain injuries also can result in the same kinds of findings. So, it is not just moderate to severe, but repetitive mild injuries that increase the risk. Although there may not be a direct causal relationship, certainly having a brain injury, multiple mild brain injuries or a moderate to severe brain injury increases the risk of developing neurodegenerative processes like Alzheimer's and Parkinson's.  He tells his patients that the likelihood of developing a neurodegenerative process may be there, but in each individual it can be different. We don't know specifically what it might mean for you. On average the risk may go up, but it still is very small. He talked about some potential neuro-protective treatments that might exist out there or are in the process of being looked at. He stated that this patient population is heavily heterogeneous, especially in how it presents and responds to trauma. Additionally, patients in the U.S. don't all receive exactly the same treatment after their trauma, which is a confounding variable that results in a very different outcome for each of those kinds of patients. Nutrition is a highly important factor when it comes to recovery and outcomes.  Parenteral nutrition goes a long way in helping their outcomes. It also is important to keep an eye on vitamin and mineral levels.  Zinc is a key supplement for many patients and magnesium can help in recovery. He closed by describing a disorders of consciousness program at his institution called the Emerge Program. A Question &Answer period followed.  

The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.  Dr. Darryl Kaelin is the Endowed Chair of Stroke and Brain Injury Rehabilitation at the University of Louisville. In this Grand Rounds session, he speaks about Traumatic Brain Injury and its Association with Neurodegenerative Disorders. Part 1 Dr. Kaelin described the interesting relationship between the University of Louisville Frazier Rehabilitation Institute and NYU Rusk in New York. The Institute has its origins at NYU. His presentation had a focus on cellular level and pathophysiology that contribute to complications of brain injury, Alzheimer's type dementia, Parkinson's Disease and some similarities that exist. He began a literature review one-year ago on this topic, which has led to today's discussion. It is important to start by talking a little about the pathophysiology TBI and cerebral insults. It can have some correlation to stroke and other insults to the brain and central nervous system. He also talked a little bit about things that we don't think about much as physiatrists –astrocytes and microglia and what their roles are in the brain and in brain trauma. He indicated that astrocytes are the scaffolding or the structure upon which neurons and other cells hold themselves to and create the structure and shape of the brain. Microglial cells help in brain infection and brain inflammation. In a resting, healthy brain they are highly mobile and will undergo morphological changes following a brain trauma. He indicated that synapses between neurons are significantly affected both mechanically and in becoming lost in severe brain injury. He discussed the importance of sleep for patients with a brain injury. Part 2 Repetitive mild brain injuries also can result in the same kinds of findings. So, it is not just moderate to severe, but repetitive mild injuries that increase the risk. Although there may not be a direct causal relationship, certainly having a brain injury, multiple mild brain injuries or a moderate to severe brain injury increases the risk of developing neurodegenerative processes like Alzheimer's and Parkinson's.  He tells his patients that the likelihood of developing a neurodegenerative process may be there, but in each individual it can be different. We don't know specifically what it might mean for you. On average the risk may go up, but it still is very small. He talked about some potential neuro-protective treatments that might exist out there or are in the process of being looked at. He stated that this patient population is heavily heterogeneous, especially in how it presents and responds to trauma. Additionally, patients in the U.S. don't all receive exactly the same treatment after their trauma, which is a confounding variable that results in a very different outcome for each of those kinds of patients. Nutrition is a highly important factor when it comes to recovery and outcomes.  Parenteral nutrition goes a long way in helping their outcomes. It also is important to keep an eye on vitamin and mineral levels.  Zinc is a key supplement for many patients and magnesium can help in recovery. He closed by describing a disorders of consciousness program at his institution called the Emerge Program. A Question &Answer period followed

Nesse episódio especial em parceria com a Cardinal Health, o NutritotalCast recebe a nutricionista Camila Prim para discutir sobre os sinais e impactos da desidratação em pacientes com nutrição enteral.Ela destaca ferramentas, protocolos e diretrizes baseadas em evidências para garantir que cada paciente receba a quantidade adequada de líquidos que é essencial para a evolução do quadro clínico no hospital.Entrevistada: Camila Prim - Nutricionista especialista em Nutrição Enteral e Parenteral pela BRASPENHost: Ana Carolina Costa Vicedomini - Nutricionista e coordenadora de inovação no Ganep Educação e Nutritotal#nutrição #nutriçãoenteral #nutricaohospitalar #nutricaoclinica #podcast

In this episode of The Top Line, sponsored by the Parenteral Drug Association (PDA), we explore the upcoming PDA/FDA Joint Regulatory Conference, happening September 9-11 in Washington, D.C. Our guest, Janeen Skutnik-Wilkinson, Director of Global Quality Regulatory Surveillance and External Engagement for Moderna and Co-Chair of the 33rd annual event, shares why this conference is the essential annual CGMP event to attend. Janeen notes the direct access to federal regulators and the unique insights from FDA colleagues as standout features. The FDA co-sponsored conference is known for fostering collaboration among scientific minds to create practical solutions and best practices, with this year's focus on improving quality culture, shifting to proactive approaches, and evolving quality maturity. Key sessions will cover de-risking quality control environments by utilizing case studies on OOS and OOT results, and enhancing lab systems with QRM. The conference's focus on Current Good Manufacturing Practices (CGMP) makes it a must attend for quality assurance and operations professionals. Additionally, discussions will delve into the role of AI in manufacturing and data integrity. For a comprehensive look at this year's PDA/FDA Joint Regulatory Conference, listen to the full episode and register at pda.org/PDAFDA2024.See omnystudio.com/listener for privacy information.

Listeners of Off the Record may recall our episodes on the OIG audit of severe malnutrition directed at North Carolina based Vidant, now ECU Health. Vidant/ECU won a landmark case against the OIG in large part because it had a multidisciplinary clinical and coding team in place to ensure that severe and other forms of malnutrition were appropriately documented in the record and captured. That effort was spearheaded by CDI and coding experts, but also by a great clinical team including my guest today. Ashley Strickland is the adult clinical dietitian supervisor and an surgical/trauma intensive care dietitian at ECU Health. Her primary focus is critical care, complex GI patients, and nutrition support. She's also an independent contractor and educator for the Academy of Nutrition and Dietetics and sits on the American Society for Parenteral and Enteral Nutrition's Reimbursement Malnutrition Task Force. On this show we cover: • What is a hospital based registered dietitian (RD), and Ashley's life-saving clinical work supporting critical care/trauma/surgical intensive care patients • How her work impacts documentation/coding/diagnosis of malnutrition and obesity • Strategies for appropriate capture of severe and other forms of malnutrition • The OIG case from Ashley's perspective, including prepping with mountains of paper records in the war room, courtroom experiences, and lessons learned • Advice for professionals dealing with egregious denials, including flimsy justifications of “not enough care” directed at a condition, or denying conditions clearly reportable per Official Guidelines for Coding and Reporting • Definitions and controversies: AND/ASPEN criteria vs. the Global Leadership Initiative on Malnutrition (GLIM), and compliance concerns with the emergence of “mild” malnutrition • My Dave Matthews gaffe (sorry, heavy metal guy here)

Andrea Adler, RD, CSPCC, LD, is a board certified specialist in pediatric critical care nutrition and has worked as a Pediatric Dietitian at the Cleveland Clinic Children's Hospital for over 19 years.  She's worked with the neonatal population since 2004 and, about 10 years ago, expanded her practice to include pediatric patients with intestinal failure, liver failure and organ transplantation.  She currently volunteers as RD Co-Chair of the Pediatric Intestinal Failure Work Group Subcommittee of the American Society for Parenteral and Enteral Nutrition, and was Andrea recently received the Recognized Neonatal Dietitian award from Pediatric Nutrition Practice Group from the Academy of Nutrition and Dietetics.  When she is not working, she enjoys spending her time at her daughter's swim meets or her son's wrestling matches and enjoys riding with her virtual friends on her “bike that goes nowhere”.  This episode was hosted by Christina M. Rollins MBA, MS, RDN, LDN, CNSC, FAND and was recorded on 1/10/24.

Brandy Hernandez, PharmD reviews approaches to nutritional need assessment in critical care. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes. You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

In this podcast, Editor-in-Chief Dr. Jeanette Hasse interviews Lisa Epp, the first author of the paper “Blenderized tube feedings: Practice recommendations from the American Society for Parenteral and Enteral Nutrition” published in the December 2023 issue of Nutrition in Clinical Practice. Lisa Epp is a registered dietitian with the Division of Endocrinology, Diabetes., Metabolism, and Nutrition at the Mayo Clinic in Rochester MN. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US December 2023

Iniciamos o último mês de 2023 apresentando mais 4 artigos no nosso Journal Club. 1. When the Unknown Is Unknowable: Confronting Diagnostic Uncertainty, publicado no Pediatrics de Outubro de 2023, um artigo surpreendente, que aborda uma das maiores dificuldades da medicina: a incerteza diagnóstica diante de um quadro muito grave e com risco de vida. Disponível em https://publications.aap.org/pediatrics/article-abstract/152/4/e2023061193/193942/When-the-Unknown-Is-Unknowable-Confronting?redirectedFrom=fulltext2. Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis ofobservational studies. Nosso segundo artigo, publicado no Journal of Maternal-Fetal and Neonatal Medicine, aborda a dúvida nossa de todos os dias. Afinal, é sepse precoce ou não é? Disponível em: https://doi.org/10.1080/14767058.2023.22590493. Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition. Quando iniciar a NPT em prematuros? Qual a dose adequada de aminoácidos? Qual a melhor solução de lipídeos? Respostas baseadas em evidências para essas e outras dúvidas aqui: https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.25504. Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm InfantsA Secondary Near-Infrared Spectroscopy Study of the Transfusion of PrematuresRandomized Clinical Trial (TOP NIRS). Será que o NIRS vai nos ajudar a definir qual o melhor momento para transfundir prematuros? Descubra em: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809782 Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Se estiver gostando do nosso Podcast, por favor deixe sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org

Episode 10 - The Past, Present, and Future of Blenderized Tube FeedsIn this episode of Nutrition Pearls: the Podcast, Melissa Talley and Bailey Koch host dietitian Sharon Weston.  Sharon is a Registered Dietitian and Board Certified Specialist in pediatric nutrition. She works with a variety of specialities within GI and takes a special interest in blenderized formulas at Boston Children's Hospital.  As a recognized authority on the dietary and nutritional management of blended foods, Sharon is a frequently invited speaker at GI conferences. She has contributed her expertise to articles related to blenderized formula including:  Stir, Shake or Blend: A Comparison of Methods Used to Reduce Viscosity of Blenderized Tube Feedings, JPGN July 1, 2022, and Determining Viscosity of Blenderized Formula:  A Novel Approach Using the International Dysphagia Diet Standardisation Initiative Framework, JPEN 2020. During this episode she will discuss blenderized feeds and nutrition considerations and management. Resources:1. Cassandra Walia, Megan Van Hoorn, Angela Edlbeck, Mary Beth Feuling, The RegisteredDietitian Nutritionist's Guide to Homemade Tube Feeding, Journal of the Academy of Nutritionand Dietetics, Volume 117, Issue 1, 2017, Pages 11-16.2. Bobo. (2016). Reemergence of Blenderized Tube Feedings. Nutrition in Clinical Practice, 31(6),730–735.3. Bennett, Hjelmgren, B., & Piazza, J. (2020). Blenderized Tube Feeding: Health Outcomes andReview of Homemade and Commercially Prepared Products. Nutrition in Clinical Practice, 35(3),417–431.4. Epp, Blackmer, A., Church, A., Ford, I., Grenda, B., Larimer, C., Lewis‐Ayalloore, J., Malone, A.,Pataki, L., Rempel, G., & Washington, V. (2023). Blenderized tube feedings: Practicerecommendations from the American Society for Parenteral and Enteral Nutrition. Nutrition inClinical Practice. https://doi.org/10.1002/ncp.11055Nutrition Pearls is supported by an educational grant from Reckitt Mead Johnson NutritionProduced by: Megan Murphy NASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org

Parenteral Nutrition (PN) therapy can be safely administered in the long-term care setting with the appropriate preparations. These include nursing education on administration and care of patients receiving PN, updated policies/procedures, skills checklists, and having additional PN resources available.

Ben and Daphna are dissecting the American Society for Parenteral and Enteral Nutrition's latest paper that digs into significant clinical questions regarding TPN use in the NICU for preterm infants. Join us as we put under the microscope topics like the initiation of parental nutrition, the optimum dosage of amino acids, and the impact of altering intralipid composition on growth outcomes. We're not just delivering information; we're assessing the robustness of these recommendations and the quality of evidence backing them up.  As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Dr. Laura Matarese, PhD, RDN, LDN, FADA, FASPEN, FAND is a Professor of Medicine in the Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine and Adjunct Professor of Surgery at the Brody School of Medicine at East Carolina University in Greenville, NC. She has over 40 years of experience in nutrition support and gastrointestinal nutrition, and is the author of numerous manuscripts, abstracts, chapters and books, including the new second edition of The Health Professionals Guide to Gastrointestinal Nutrition.  Dr. Matarese currently serves on the editorial boards of several journals, has lectured extensively, both nationally and internationally, and has held numerous positions within the Academy of Nutrition and Dietetics, the Commission on Dietetic Registration, and the American Society for Parenteral and Enteral Nutrition.  She is the past president of the National Board of Nutrition Support Certification and currently serves as a Councillor for the Obesity, Metabolism and Nutrition section of the American Gastroenterological Association and on the Board of Advisors of the Oley Foundation.  She is the recipient of numerous honors and awards and, prior to joining East Carolina University, held positions at the University of Cincinnati Medical Center, the Cleveland Clinic, and the Starzl Transplant Institute at the University of Pittsburgh. This episode was recorded on 7/18/23 and is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC.

In this podcast, JPEN Editor-in-Chief Dr. Kenneth Christopher, interviews Dr. Liam McKeever assistant professor and clinical nutrition epidemiologist at Rice University, and director and editor-in-chief of the ASPEN Clinical Guidelines, discussing the new guidelines for Parenteral Nutrition in Preterm Infants. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US September 2023

This episode features registered dietitian nutritionists Alison Creeden and Jennifer Bryant, here to talk with us about their recent publication in National Home Infusion Association's magazine entitled Concurrent Enteral and Parenteral Nutrition Support. Alison Creeden, MS, RD, LDN, CNSC obtained a Bachelor of Science degree in Nutrition from Simmons University followed by a Master of Science degree in Nutrition from the University of Massachusetts, Amherst. Over the last eleven years, she has specialized in oncology nutrition, working at multiple Boston-based hospitals including Mount Auburn Hospital, Brigham and Women's Hospital and most recently Beth Israel Deaconess Medical Center (BIDMC).  In 2019, she became the outpatient head and neck cancer dietitian at BIDMC following her experience as an inpatient oncology dietitian and critical care dietitian and in January 2022, she transitioned to home infusion,  specializing in patients on home parenteral nutrition. Jennifer Bryant, MS, RD, CSO, LD, CNSC, is a registered dietitian, licensed nutritionist, nutrition support clinician, and board certified specialist in oncology nutrition.  She works alongside Alison caring for home infusion as well as holds adjunct faculty positions at Southern Maine Community College, The University of Southern Maine, and The University of New England where she has taught nutrition for the last 14 years. This episode is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC and was recorded on 6/14/23.

Dr. Paul Wischmeyer, MD, EDIC, FCCM, FASPEN is a board certified anesthesiologist and Professor with Tenure at Duke University School of Medicine, currently serving as Associate Vice Chair for Clinical Research in the Department of Anesthesiology and Director of the Nutrition Team at Duke Hospital. His research interests include surgical and critical care nutrition and exercise rehabilitation therapy, parenteral nutrition and personalized nutrition trials, perioperative optimization, post-illness muscle mass and functional recovery, and role of probiotics/microbiome in illness, specifically COVID-19 prevention and treatment. Dr. Wischmeyer has received significant funding from the National Institutes of Health and US Department of Defense as well as numerous awards for his work from national and international societies, including the Jeffrey Silverstein Award and Memorial Lecture for Humanism in Medicine from the American Delirium Society, Fellow of the Society of Critical Care Medicine (FCCM), the John M. Kinney Award for the most significant contribution to the field of general nutrition, and the Stanley Dudrick Research Scholar Award provided by the American Society for Parenteral and Enteral Nutrition where he is also recognized as an honorary Fellow. He has over 200 publications in nutrition, critical care, and perioperative care, including publications in New England Journal of Medicine. He has been an invited speaker at numerous national and international medical meetings, delivering over 1,000 invited presentations in his career and is an advocate and lecturer for improving the patient experience and teaching providers to keep CARE as the focus of healthcare. This episode is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, CNSC, FAND and was recorded on 6/9/2023. Dr. Wischmeyer has disclosed financial relationships with Baxter, Fresenius Kabi, Abbott, DSM, National Institutes of Health, US Department of Defense to Duke University, MuscleSound, and Nutricia/Danone.

In this episode of Quah (Q & A), Sal, Adam & Justin answer four Pump Head questions drawn from last Sunday's Quah post on the @mindpumpmedia Instagram page.  Mind Pump Fit Tip: GET your testosterone levels checked! (1:41) The demonization of fitness is getting more nefarious. (11:46) Casa Bonita, the ultimate restaurant experience. (39:32) Fitness and epigenetics. (43:57) The importance of 3rd party testing with your favorite protein powder. (46:22) Everything is amplified today. (47:57) Why are electric vehicles piling up? (53:26) Shout out to Brandon Harris. (55:50) Hiya is an excellent multivitamin for kids. (56:14) #Quah question #1 - From watching YouTube Mind Pump clips and Squat University, I realized a wider stance with toes pointed outwards substantially adds depth to my squat. How can I tell if I'm masking ankle/hip mobility issues or if it's just my anatomy? (58:05) #Quah question #2 - How does a supinated, pronated, and neutral grip change or affect an exercise? (1:02:01) #Quah question #3 - I am someone who can't connect to their glute muscles very well when I squat so would it be better to go lighter on the movement and work on the mind-to-muscle connection or just continue to go heavy? Will I still see gains if I drop the weight? (1:08:20) #Quah question #4 - In a recent episode, you guys mentioned avoiding processed foods as in anything in a wrapper or package. Does this mean that while eating a whole-food diet we would need to avoid Cheese!? (1:10:59) Related Links/Products Mentioned Visit Organifi for the exclusive offer for Mind Pump listeners! **Promo code MINDPUMP at checkout** Visit Hiya for an exclusive offer for Mind Pump listeners! July Promotion: MAPS Starter | MAPS Starter Bundle 50% off! **Code JULY50 at checkout** Pesticide atrazine can turn male frogs into females Hormone Replacement Therapy Market (By Product: Oestrogen Hormone Replacement Therapy, Human Growth Hormone Replacement Therapy, Thyroid Hormone Replacement Therapy, Testosterone Hormone Replacement Therapy; By Route of Administration: Oral, Parenteral, Transdermal, Others; By Indication; By Distribution Channel) - Global Industry Analysis, Size, Share, Growth, Trends, Regional Outlook, and Forecast 2022-2030 TRANSCEND your goals! Telehealth Provider • Physician Directed GET YOUR PERSONALIZED TREATMENT PLAN!  Hormone Replacement Therapy, Cognitive Function, Sleep & Fatigue, Athletic Performance and MORE. Their online process and medical experts make it simple to find out what's right for you. Testosterone Administration Induces A Red Shift in Democrats An Inconvenient Truth About ESG Investing - Harvard Business Review Inside the Reopening of Casa Bonita With Trey Parker and Matt Stone Identical twin study sheds light on how exercise tunes our genes Arsenic, Lead Found in Popular Protein Supplements Electric car inventory grows as sales struggles to keep up Visit Kreatures of Habit: Meal One for an exclusive offer for Mind Pump listeners! **Code MP25 at checkout** Adam Schafer's DEEP Squat Mobility Secrets | Behind The Scenes at Mind Pump MAPS Prime Pro Webinar Build Your Biceps with Angles – Mind Pump TV Build Your Triceps with Angles – Mind Pump TV Mind Pump #2065: Glute Masterclass Hip thrust and back squat training elicit similar gluteus muscle hypertrophy and transfer similarly to the deadlift Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned Brandon Harris (@higher__human) Instagram Squat University (@squat_university) Instagram Bret Contreras PhD (@bretcontreras1) Instagram  

Crafting parenteral nutrition orders is challenging enough without the added pressure of PN ingredient shortages. For over 30 years, dietitians and nutrition support professionals have dealt with product shortages. This can create a wave of complications for your PN patients. Tune in to find out what you can do to weather this storm.  Claim CE credit for this episode: https://bit.ly/3K2sBS6 Show Notes:  ASPEN's Appropriate Dosing for Parenteral Nutrition pdf: https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/PN%20Dosing%201-Sheet-Nov%202020-FINAL.pdf   ASPEN's Parenteral Nutrition Shortages webpage: https://www.nutritioncare.org/Guidelines_and_Clinical_Resources/Parenteral_Nutrition_Product_Shortages/  

Glenn Wright, President and CEO of Parenteral Drug Association (PDA), sat down with Cell & Gene: The Podcast's Erin Harris at the 2023 PDA ATMP conference to discuss not only the conference's theme, “Navigating Through CMC Challenges,” but also Wright's take on CGT manufacturing strategy based on his years in industry. Wright shares his insight on the past, present, and future of the cell and gene therapy space.

Hoje recebemos Diogo Toledo! 

Médico, residente em clínica médica. Dedicou seus últimos anos de estudo realizando mestrado e doutorado em composição corporal. Ele tem se aventurado em trazer novas tecnologias para o mundo médico e se dedicado a medicina de precisão. Trabalha para que o universo corporativo, aliado a medicina, tragam a inteligência artificial aos hospitais e consultórios.
 Também faz a gestão da equipe de terapia nutricional do Hospital Albert Einstein! Em 2018, como presidente da Sociedade Brasileira de Nutrição Parenteral e Enteral (BRASPEN) criou a campanha “Diga Não à Desnutrição” para ajudar a implementar as melhores práticas de nutrição hospitalar e a combater a desnutrição nos hospitais brasileiros!!! 

Neste episódio conhecemos mais das suas de seu estilo de vida e chamado que vêm impactando de maneira expansiva as pessoas ao seu redor e a sociedade.

The updated guidance went into effect in October 2022 and focuses on employing strategies to prevent infusion catheter related infections and complications. Key elements of the new guidance include more detailed assessment of the vascular access device and the resident's ability to report signs and symptoms of complications. Is your facility prepared?

In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls. References 1.         Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517. 2.         Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41. 3.         McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Surgical Critical Care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/

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Host: Juan Carlos Simó (@jc_simo), Psicólogo Clínico, Dietista Funcional (IFM), Fellowship en biología y metabolismo vascular (A4M), Endocrinología Aplicada (A4M), Functional and Hypertrophy Strength Coach (PICP level 3). Invitado 1: Dra. Maureen Comarazamy, Médico internista, Especialista en Nutrición Clínica, Enteral y Parenteral. Invitado 2: Verónica Rodríguez, Lic. Psicología industrial, Gerencia de Recursos Humanos. Encuéntranos en Spotify y Youtube. #HumanPerformance #JCSimo #Lifestyle #Saludybienestar #Alimentacionquesana #TheSimoDiet #dieteticafuncional #training

Anne Tucker, PharmD, BCNSP, is a Clinical Pharmacy Specialist in Critical Care/Nutrition Support at the University of Texas MD Anderson Cancer Center. She received her BS in chemistry/biochemistry from the University of Arkansas and Doctor of Pharmacy from the University of Arkansas for Medical Sciences where she also completed residency training. Dr. Tucker's areas of interest include fluid and electrolyte disorders, nutrition support in critically ill cancer patients, and the promotion of safe parenteral nutrition practices. She is active in the American Society for Parenteral Nutrition (ASPEN) and has done numerous webinars and platform presentations to enhance nutrition support knowledge and improve patient safety. Listen in as we chat about the role of the pharmacist in ensuring safety for patients receiving parenteral nutrition. This episode is hosted by Christina Rollins, MBA, MS, RDN, LDN, CNSC, FAND and recorded on 12/20/22.

JPEN editor-in-chief Dr. Kenneth Christopher speaks with Dr. Manpreet Mundi, professor of Medicine at the Mayo Clinic in Rochester, MN about his JPEN reviewed article “Management of long-term home parenteral nutrition: Historical perspective, common complications, and patient education and training”. The text included in the description of the podcast Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US January 2023

In this episode, we chat with Registered Dietitian Nutritionist Kristen M Roberts, PhD, RD, LD, CNSC, FASPEN, FAND. Kristen has 17 years clinical experience in gastrointestinal failure, gut rehabilitation and nutrition support. Currently, she holds a joint appointment within the Division of Gastroenterology, Hepatology and Nutrition and the School of Health and Rehabilitation Sciences at The Ohio State University as an Associate Professor. Her clinical expertise is caring for patients with various GI illnesses, including dysmotility and malabsorptive syndromes. She has authored various original research articles and textbooks including a textbook titled, “Adult Short Bowel Syndrome: Nutritional, Medical, and Surgical Management”. Prior to her employment with OSU, Kristen completed her PhD in Human Nutrition with a specialization in biomedical clinical and translational science, and she has an active research program understanding the impact of dietary patterns on chronic inflammatory condition. She is a fellow of the Academy of Nutrition and Dietetics and of the American Society for Parenteral and Enteral Nutrition and a Certified Nutrition Support Clinician and serves as the Associate Editor for Nutrition in Clinical Practice. This episode is hosted by Christina Rollins, MBA, MS, RDN, LDN, FAND, CNSC and was recorded on 12/18/22.

In this episode of the DNS Podcast, we feature registered dietitian nutritionist, Heather Stanner, MS, RD, LD, CNSC. Stanner is the author of a recent publication in the Journal of Parenteral and Enteral Nutrition entitled Impact of Infusion Frequency on Quality of Life in Patients Receiving Home Parenteral Nutrition. Join us as we learn more about Stanner's research outcomes and advice for dietitians working in the home infusion industry. This episode is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC, and was recorded on 9/13/22. Speaker disclosure: Received honoraria from Baxter Healthcare for participation in an educational video series.

This podcast is made possible through an educational grant from Baxter Healthcare. In this episode, we chat with board certified nutrition support pharmacist Dr. Lingtak-Neander Chan. Dr. Chan currently serves as a Professor of Pharmacy in the School of Pharmacy and is on the Interdisciplinary Faculty of the Graduate Program in Nutritional Sciences at the University of Washington, Seattle. His primary research focus is on the absorption kinetics of micronutrients and drugs after bariatric surgery and other GI tract repairs. Other key areas of interest include micronutrient deficiencies, intestinal failure, and critical care nutrition. Dr. Chan served as 44th President of the American Society for Parenteral and Enteral Nutrition (ASPEN) between 2019-2020, is an Associate Editor for the Journal of Parenteral and Enteral Nutrition (JPEN), and has published book chapters, review articles, original research papers and invited editorials, and has been an invited speaker at numerous scientific and professional conferences both nationally and internationally. In addition, Dr. Chan is an elected fellow of the American College of Clinical Pharmacy (ACCP) and the American Society for Parenteral and Enteral Nutrition (ASPEN). This episode is hosted by Christina M. Rollins, MBA, MS, RDN, LDN, FAND, CNSC and was recorded on 10/5/2022.

https://www.patreon.com/theemttutor This lecture/podcast is part of the Pharmacology Block series. By the end of this lecture, the student should have an understanding of the following: Knowledge Domains: Define the following key terms: Pharmacodynamics, Intended Effects, Indications, Side Effects, Unintended Effects, Untoward Effects, Contraindications Generic versus Trade name medication Enteral versus Parenteral medications Routes of medication administration: Rectal, Oral, Intravenous, Intraosseous, Subcutaneous, Intramuscular, Inhalation, Sublingual, Transcutaneous Forms of medications: Solid, Liquid, Gas The Six Rights of Medication Administration Direct Orders versus Standing Orders Peer-assisted, Patient-assisted and EMT-administered medications Medications used by EMTs – Lecture 1 of the Pharmacology Block Medications administration to pediatrics, geriatrics, and pregnant patients Steps for auto-injector Understanding patient medications (prescribed and OTC) Medication Errors --- Send in a voice message: https://anchor.fm/thepublicsafetyguru/message

In this pediatric-focused presentation planned in cooperation with the Section of Clinical Specialists and Scientists, our content matter expert reviews the neonatal and pediatric requirements for macronutrients and micronutrients and the characteristics of this population's specific parenteral nutrition products affect the solubility and stability of the formulation.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

In this podcast, Editor-in-Chief Dr. Jeanette Hasse, interviews Stephen Adams and Dr. Joseph Boullata, two of the authors of the ASPEN Consensus Statement “Safe care transitions for patients receiving parenteral nutrition” published in the June 2022 issue of NCP. June 2022 Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US

Nutrition support is one of those topics that can be confusing for dietetic interns and new dietitians.  This episode clarifies the difference between tube feeding (enteral nutrition) and parenteral nutrition by breaking down key aspects of each type of nutrition support. While the abbreviations "TF" and "TPN" both start with the same letter, it doesn't mean they're the same.  Nutrition support questions are fair game on the RD exam.  To break this concept down even further and make things easier, I created a free cheat sheet explaining the difference between tube feeding and Parenteral nutrition. Get your free copy here: https://awesome-artisan-4179.ck.page/23279b850d  

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat. My name is Rahul Damania and we come to you from Children's Healthcare of Atlanta-Emory University School of Medicine. Today's episode Is part two of our pediatric post-cardiac arrest care syndrome If you have not yet listened to part one, I would highly encourage you to visit that episode prior to delving into this one. Part 1 addressed the epidemiology, causes, and pathophysiology of POST CARDIAC ARREST SYNDROME. Part 2 Today will discuss management and complications related to post-cardiac arrest syndrome in the ICU. To revisit our index case we had a: 11 yo previously healthy M who was admitted to the PICU after cardiac arrest. After stabilization: The patient was taken to head CT which showed diffuse cerebral edema and diffusely diminished grey-white differentiation most pronounced in the basal ganglia. He is now 18-24 hours post-cardiac arrest and the team is dealing with hemodynamic changes, arrhythmias, and difficulty with ventilation. The patient's neurological exam still remains poor with fixed 5 mm pupils and upper motor neuron signs in the lower extremities. Let's get right into it: What are some of the principles in management of patients with post cardiac arrest syndrome (PCAS)? Where do we keep the patients blood pressure? Hypotension after ROSC is commonly encountered in children with PCAS. Early hypotension occurred in 27% of children after cardiac arrest is associated with lower survival to hospital discharge and unfavorable neurological outcome. When post-cardiac arrest hypotension is present, it is not clear whether increasing the blood pressure through administration of fluids and inotropes/vasopressors can mitigate harm, despite this 41% of patients under 18 receive vasopressor therapy within the first 6 hours after ROSC. Currently, there is no high-quality evidence to support any single specific strategy for post-cardiac arrest hemodynamic optimization in children. Treatment of post-cardiac arrest hypotension and myocardial dysfunction may be assisted by monitoring and evaluating arterial lactate and central venous oxygen saturation. Parenteral fluids, inotropes, and vasoactive drugs are to be used as needed to maintain a systolic blood pressure greater than the fifth percentile for age. Appropriate vasoactive drug therapies should be tailored to each patient and adjusted as needed. What about cardiac arrhythmia's such as Vtach seen in our patient? The rhythm disturbances observed during the post-cardiac arrest period include premature atrial and ventricular contractions, supraventricular tachycardias, and ventricular tachycardias. Heart block is unusual but can be observed as a manifestation of myocarditis. There is inadequate evidence in adults and no published studies in children to support the routine administration of prophylactic antiarrhythmics after ROSC, but rhythm disturbances during this period may warrant therapy. Treatment depends on the cause and hemodynamic consequences of the arrhythmias. Premature depolarizations, both atrial and ventricular, usually do not require therapy other than maintenance of adequate perfusion and normal fluid and electrolyte balance. Ventricular arrhythmias may signify more serious myocardial dysfunction. QT prolonging agents must be avoided. Many of the vasoactive agents used to support myocardial function can increase myocardial irritability and risk of arrhythmias. Premature atrial or ventricular depolarizations are frequently observed and can be controlled by optimizing the dose of the vasoactive drugs. Bradycardia is frequently seen in TTM and typically requires no therapy. During PCAC, mechanical circulatory support (ECMO) may be considered if significant cardiorespiratory instability persists despite appropriate volume expansion and administration of inotropes, vasopressors, and, if indicated,http://antiarrhythmics.in (...

Interview with Xinying Wang, MD, author of Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery: A Randomized Clinical Trial Hosted by Amalia Cochran, MD. Read Transcript

In this episode, we review the high-yield topic of Total Parenteral Nutrition (TPN) from the Nutrition section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets