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ObjectiveThis study aimed to explore the lived experiences and coping strategies of patients with short bowel syndrome (SBS) prescribed teduglutide and weaning off home parenteral nutrition (HPN), and to compare the quality of life (QOL) of these patients to patients with SBS but not prescribed teduglutide.MethodsA qualitative study was conducted, with patients recruited from a specialist HPN clinic. Participants completed handwritten semi-structured daily diaries for 6 weeks and a validated Home Parenteral Nutrition-Quality of Life (HPN-QOL) paper-based questionnaire as part of what aimed to be a mixed methods cross-tracks study. Participants were age-matched with patients with SBS receiving HPN but not prescribed teduglutide, and these ‘controls’ also completed the HPN-QOL questionnaire. Data analysis involved qualitative analysis of diary entries using grounded theory methodology and descriptive analysis of HPN-QOL questionnaire responses.ResultsFive participants completed the study and were matched with four ‘controls’. All participants and ‘controls’ reported a high QOL with no differences observed between patients prescribed and not prescribed teduglutide. Qualitative analysis revealed that participants engaged in iterative cycles of problem-focused action and emotion-focused coping strategies to manage their condition and wean off parenteral nutrition (PN). Key subthemes included polyphagia and pleomorphism in diet, fatigue-related emotional distress and positive reframing using an objective scientific lens. Decisional regret was absent, participants agreed that treatment with teduglutide was the right choice for them, despite its challenges. Their goal of independence from PN was the main motivating factor.ConclusionThis study provides valuable insights into the lived experiences and coping strategies of patients with SBS prescribed teduglutide to wean off PN. The findings underscore the importance of healthcare teams understanding these everyday challenges to facilitate shared decision-making and tailor care plans. Further research is needed to explore the long-term impact of teduglutide on QOL, including the validation of tools to screen for fatigue-related emotional distress and the development of targeted interventions to support patients during the weaning process.

Patients on home parenteral nutrition (HPN) are dependent on central venous access for long-term sustenance, and catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality in this patient population. As such, there is much interest in finding new methods for preventing CRBSIs in patients on HPN. As it is thought that these infections are preceded by microbial colonization of the catheter, one approach is to use antimicrobial catheter lock solutions. Although antibiotic catheter lock solutions have been present for decades, their use has been mostly limited to the treatment of CRBSIs due to concern for promoting microbial resistance. Recently, however, with the advent of non-antibiotic antimicrobial catheter lock solutions, this approach is gaining popularity as a promising method to decrease rates of CRBSI in HPN patients.

A combination of enteral (EN) and parenteral nutrition (PN) is often used as a strategy to optimize nutritional intake in critically ill patients; however, the effects of this intervention on clinically important outcomes have not been widely studied. This paper systematically reviewed studies that compare EN + PN to enteral nutrition (EN) alone in critically ill patients. We searched bibliographic databases, personal files, and relevant reference lists to identify randomized controlled trials that compared combination EN + PN to EN alone. Only five studies met the inclusion criteria. In all these studies PN was started at the same time as EN in the experimental group. When the results of these trials were aggregated, EN + PN had no significant effect on mortality. There was no difference between the two groups in rates of infectious complications, length of hospital stay, or ventilator days. In critically ill patients who are not malnourished and have an intact gastrointestinal tract, starting PN at the same time as EN provides no benefit in clinical outcomes over EN alone. More research is needed to determine the effects of combination EN + PN on clinical outcomes in critically ill patients who are poorly intolerant to EN.

•Patients with short bowel show clinical instability with secretion of magnesium from their stoma making intravenous (IV) magnesium the only safe treatment.•Teduglutide is a glucagonlike peptide that proliferates microvilli and enhances calorie and hydration absorption.•Previously, it was not known whether teduglutide was able to break IV magnesium dependency.•This is the first report to track increasing magnesium in two patients on teduglutide and to determine that management was safe without IV.•The increase in magnesium occurred at the time that onset of action of the drug was observed in other studies. It is not known whether Teduglutide can allow patients with Short bowel syndrome, previously dependent on continuous or periodic intravenous (IV) magnesium, to attain oral autonomy with or without supplementation. Here, we report on two patients previously dependent on continuous or intermittently administered IV magnesium to achieve autonomy from IV, one with and one without oral supplementation that was previously ineffective in both patients.

Purpose Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides derived from soybean oil (SO). SO-containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to products containing SO emulsion only. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients. Methods We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition. Results A total of 12 RCTs met the inclusion criteria. When the results of these RCTs were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio, RR 0.83; 95 % confidence intervals, CI 0.62, 1.11; P  = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57; 95 % CI −5.51, 0.37; P  = 0.09), and in ICU length of stay (LOS) (WMD −2.31; 95 % CI −5.28, 0.66; P  = 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR 1.13; 95 % CI 0.87, 1.46; P  = 0.35). Conclusion Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

Problem-based learning (PBL) is an instructional strategy that is poised for widespread application in the current, growing, on-line digital learning environment. While enjoying a track record as a defensible strategy in face-to-face learning settings, the research evidence is not clear regarding PBL in on-line environments. A review of the literature revealed that there are few research studies comparing on-line PBL (oPBL) to face-to-face PBL, and, in these, findings have been mixed. This study is a combined meta-analytic and qualitative review of the existing research literature comparing oPBL to face-to-face PBL. The study's aim is to: 1. Detect the presence and magnitude of the effectiveness of oPBL; 2. Uncover and identify the factors that contribute or explain the effectiveness of oPBL. This review used a mixed methods strategy, combining a meta-analysis with a qualitative analysis of the studies that met inclusion criteria. An overall effect size was found to be slightly in favour of oPBL in terms of student performance outcomes. The qualitative analysis revealed relationships between established concepts of learning. The observations in this systematic review help reduce uncertainty about the robustness of PBL as in instructional strategy delivered in the online environment. [PUBLICATION ABSTRACT]

Background: This case report describes our preliminary data on the use of taurolidine as a lock technique. Taurolidine is a novel antimicrobial agent that has found a niche in Europe for prevention of bacteremia in home parenteral nutrition (HPN) patients who have multiple catheter-related bloodstream infections. Methods: A 29-year-old male with short bowel syndrome was admitted 18 times in 9 years for treatment of Gram-positive, Gram-negative, and yeast-associated catheter-related bloodstream infections. Management consisted of conventional antibiotic treatment in accordance with blood culture and sensitivity results as well as catheter removal in 10 cases. Ten months before the last infection, the patient was instructed to instil 1.5 mL taurolidine 2% daily into his central line after finishing his HPN infusion and has continued to do so 2 years to date. Results: The incidence of catheter-related bloodstream infections decreased from 8.5 to 1.5 infections per 1000 catheter days. Conclusions: These data support previous observations made outside North America and suggest that taurolidine may prove to be an effective and safe antimicrobial agent for the prevention of recurrent catheter-related bloodstream infections. (Journal of Parenteral and Enteral Nutrition 22:242-244, 1998)

The disparate geographical patterns of resistance, combined with infrequent reporting of resistance, makes generating recommendations for second-line therapy very difficult and contentious.