Significant Publications for Pharmacy Nutrition Support Practice in 2013

Purpose:

To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature.

Methods:

Several experienced board-certified clinical pharmacists in nutrition support compiled a list of publications published in 2013 that they considered to be important to their practice. The citation list was compiled into a Web-based survey whereby pharmacist members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), GI-Liver-Nutrition Practice Research Network of the American College of Clinical Pharmacy, and the Pharmacy and Pharmacology Section of the Society of Critical Care Medicine were asked to rank each article according to level of importance in their practice.

Results:

A total of 30 articles were identified by the author group. Thirty-six participants responded to the survey. The top-ranked papers by participants from the Web-based survey were reviewed by the authors. Due to its high level of importance, the parenteral nutrition safety consensus recommendations article, to be published in 2014 by A.S.P.E.N., was also reviewed.

Conclusion:

It is recommended that the informed pharmacist, who is engaged in nutrition support therapy, be familiar with the majority of these publications.Key Words: consensus, enteral nutrition, guidelines, nutrition support, outcomes, parenteral nutritionStaying current with the literature is a requirement for the informed pharmacist who maintains an evidence-based clinical practice. This requirement has become increasingly more challenging to fulfill as a paradigm shift has changed the practice culture of a full-time pharmacy nutrition support specialist to a more integrated model whereby the clinical pharmacist provides pharmacotherapy services along with nutrition support responsibilities. This paradigm shift has arguably been partially attributed to the financially motivated decline in the provision of interdisciplinary nutrition support teams by US hospitals over the past couple of decades.¹As a result of this change, informed clinicians are responsible for staying abreast of numerous therapeutic areas that interface with their clinical practice in addition to nutrition support therapy. Keeping current with the nutrition support literature, even for the pharmacy nutrition support specialist, is a daunting if not overwhelming task. Because nutrition support therapy is integrated with many divergent specialized fields (eg, medicine, surgery, pediatrics, gastroenterology, oncology, nephrology, infectious disease, endocrinology, hepatology, transplantation, trauma, burns, home infusion, critical care, dietetics, nursing, and pharmacy), it is nearly impossible for one individual to screen the plethora of journals each month to seek out those clinical studies, position papers, or clinical guidelines that may enhance or change their clinical practice.     

Backward Flux Re-Deposition Patterns during Multi-Spot Laser Ablation of Stainless Steel with Picosecond and Femtosecond Pulses in Air

We report on novel observations of directed re-deposition of ablation debris during the ultrafast laser micro-structuring of stainless steel in the air with multi-beams in close proximity on the surface. This interesting phenomenon is observed with both 10 ps and 600 fs NIR laser pulses at 5 kHz repetition rate. Ablation spot geometries could be altered with the use of beam splitting optics or a phase-only Spatial Light modulator. At low fluence (F ~ 1.0 J cm⁻²) and pulse exposure of a few hundred pulses, the debris appears as concentrated narrow “filaments” connecting the ablation spots, while at higher fluence, (F ~ 5.0 J cm⁻²) energetic jets of material emanated symmetrically along the axes of symmetry, depositing debris well beyond the typical re-deposition radius with a single spot. Patterns of backward re-deposition of debris to the surface are likely connected with the colliding shock waves and plasma plumes with the ambient air causing stagnation when the spots are in close proximity. The 2D surface debris patterns are indicative of the complex 3D interactions involved over wide timescales during ablation from picoseconds to microseconds.     

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) collaborative quality improvement initiative in percutaneous coronary interventions

The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, cardiovascular consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality improvement program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality improvement. As the project enters into year 5, the participating centers are deeply engaged in the quality improvement phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is an example of a regional collaborative effort to assess and improve quality of care and outcomes that overcome the barriers of traditional market and academic competition.