Dudrick Symposium - Pediatric Intestinal Failure: Frontiers in Intestinal Adaptation

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Premier Paper Session and Vars Award Competition

DESCRIPTION
ASPEN is dedicated to advancing the science and practice of clinical nutrition and metabolism. This session highlights the best peer-reviewed research abstracts submitted for inclusion in CNW17. This is your opportunity to hear firsthand about the latest research that helps shape clinical practice for all disciplines involved in nutrition support.

All of the individuals who give presentations during this session are vying for the prestigious Harry M. Vars Award. This award serves as a tribute to Dr. Vars and his pioneering developments
in parenteral nutrition and is given annually for the best original research presentation by an investigator at CNW. The award recipient will be selected on site by the ASPEN Research Committee based upon a review of manuscripts submitted by qualified candidates and their presentations. The award recipient will be announced at the Rhoads Research Lecture and Award Ceremony on Tuesday morning. Come cheer on the candidates and hear the best of the best research at CNW17! 

View the 2017 Vars Candidates

MODERATORS:
Lauren Beckman, PhD, RD, Clinical Dietitian, Swedish Medical Center, Englewood, CO 
Todd Rice, MD, MSc, Assistant Professor of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
LEARNING LEVEL: Advanced
UAN: 0216-0000-17-026-L04-P
CE CREDIT: 2 hours

Gastrostomy Tube Boot Camp 

LEARNING OBJECTIVES
1. Identify the usual methods of placement of gastrostomy tubes including laparoscopic, open, and PEG placements
2. Demonstrate the appropriate procedure for replacement of a PEG, low-profile balloon, and non-balloon gastrostomy tube
3. Describe the appropriate management of complications including site issues, difficult replacements, and infections

FACULTY & TOPICS
Pediatric Laparoscopic Gastrostomy Tube Placement
Richard Hendrickson, MD

Low-Profile Balloon Gastrostomy Replacement and Sizing
Ruba Abdelhadi, MD

Non-Balloon Gastrostomy Tube Replacement
Donald George, MD

Special Considerations Regarding Gastrostomy Tube Placements
Beth Lyman, RN, MSN, CNSC

Treatment of Pediatric Gastrostomy Tube Site Issues
Katina Rahe, BSN, RN, CPN

Treatment of Adult Gastrostomy Tube Site Issues
Deborah Johnson, MS, RN, WOCN

PEG Tube Placement and Management
Matthew Bechtold, MD, FACP, FASGE, FACG, AGAF

MODERATOR: Beth Lyman, RN, MSN, CNSCASPEN is dedicated to advancing the science and practice of clinical nutrition and metabolism. This session highlights the best peer-reviewed research abstracts submitted for inclusion in CNW17. This is your opportunity to hear firsthand about the latest research that helps shape clinical practice for all disciplines involved in nutrition support.
LEARNING LEVEL: Basic
UAN: 0216-0000-17-027-L04-P
CE CREDIT: 1.5 hours

Presented by the ASPEN Pediatric Section

Malnutrition Prevalence and Outcomes: State of the Science Across the Lifespan

LEARNING OBJECTIVES
1. Identify US hospitalized patient prevalence of malnutrition based on AHRQ databrief and relation to diagnoses/procedures and readmissions
2. Outline the results from the ASPEN survey on assessment parameters and use of EHRs in documentation
3. Describe nutrition assessment variables and relationship with outcomes according to latest literature

FACULTY & TOPICS
AHRQ Databrief on Malnutrition
Peggi Guenter, PhD, RN, FAAN

ASPEN Survey on Nutrition Assessment – Adult Results
Sadeq A. Quarishi, MD

ASPEN Survey on Nutrition Assessment – Pediatric Results
Sandra Bouma, MS, RDN, CSP

Malnutrition Assessment and Outcomes
Kris Mogensen, MS, RD, LDN, CNSC

MODERATOR: Ainsley Malone, MS, RD, LD, CNSC, FAND, FASPEN
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-028-L01-P
CE CREDIT: 1.5 hours

Tube In or Tube Out – Practical Points to Think About

LEARNING OBJECTIVES
1. Identify key behavioral issues in the child and family that are important in the screening of children for tube weaning
2. Discuss behavioral concepts that can be used to promote the transition to oral feeding
3. Discuss the medical evaluation for the child with feeding problems and describe implementation and monitoring of the weaning process
4. Describe the results of the 2016 national survey from the ASPEN Enteral Nutrition Weaning Consensus Statement Committee

FACULTY & TOPICS
Assessment of Readiness for Initiating the Wean and Psychological Aspects of the Process
Ann Davis, PhD, MPH, ABPP

How Do We Know They Are Ready: Evaluation and Implementation of Feeding Tube Weaning
Sarah Edwards, DO

Describe Current Weaning Practices Identified Through a Nationwide Survey
Katherine Chessman, PharmD, BCNSP, BCPS, FCCP, FPPAG

MODERATOR: Elizabeth Bobo, MS, RD, LDN, CNSC
LEARNING LEVEL: Basic
UAN: 0216-0000-17-029-L04-P
CE CREDIT: 1.5 hours

Challenges in Providing Nutrition Support to the Critically Ill Patient with End Stage Organ Failure: A Case-Based Approach

LEARNING OBJECTIVES
1. Discuss the challenges of obtaining access and providing nutrition support to critically ill patients with end-stage liver disease as well as determining specialized nutrition requirements
2. Analyze the nutrient requirements of critically ill patients with chronic
renal failure including alterations associated with different renal replacement therapies
3. Identify nutrition support therapies and requirements for critically ill patients with heart failure especially those requiring ECMO or ventricular assist devices

FACULTY & TOPICS
Navigating the Challenges of Nutrition Support for the Critically Ill Patients
with End-Stage Liver Disease: Roadblocks and Detours
Jeanette Hasse, PhD, RD, LD, FADA, CNSC

Nutrition Support Therapy for Critically Ill Patients with Chronic Renal Failure
Erin Nystrom, PharmD, BCNSP

Nutrition Support Therapy for Critically Ill Patients with Chronic Heart Failure
Patricia M. Brown, RDN-AP, CNSC

MODERATOR: Jeanette Hasse, PhD, RD, LD, FADA, CNSC
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-030-L01-P
CE CREDIT: 1.5 hours

The Future of Nutrition Education: Multidisciplinary Approaches and Innovative Techniques

LEARNING OBJECTIVES
1. Demonstrate innovative ways in which nutrition can be incorporated into the pre-clinical Medical School Curriculum
2. Illustrate current examples of how nutrition is being taught in the clinical setting within an Inter-Professional Education framework
3. Discuss ideas on how to incorporate nutrition education into evolving education curriculum

FACULTY & TOPICS
How We Do It: Medical School of Education – The Pre-clinical and Clinical Years
Jill Cherry-Bukowiec, MD, MS, PNS, FACS

Nutrition Is Important! Weaving Nutrition Throughout the Five Year Curriculum
Gail Cresci, PhD, RD, LD, CNSC

Changing Physician Behavior Using Online Interactive Case-based Education
Humberto Marquez Arenas, MD

MODERATOR: Gordon Sacks, PharmD, BCNSP, FCCP
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-031-L04-P
CE CREDIT: 1.5 hours

Hot Topics in Clinical Nutrition

LEARNING OBJECTIVES
1. Discuss the use of Oral Nutritional Supplements (ONS) to improve patient outcomes
2. Examine the cost-effectiveness of ONS in the post-discharge period
3. Describe the new definition of chronic intestinal failure (functional, pathophysiological, and clinical) and discuss the implication in clinical practice
4. Describe the major issues of the new ESPEN Guidelines on Chronic Intestinal Failure
5. Evoke new trends in the use of home parenteral nutrition
6. Describe the mixed pathogenesis of sarcopenia
7. Recognize the clinical relevance of sarcopenia and importance of sarcopenic obesity
8. Discuss the obesity paradox

FACULTY & TOPICS
Clinical Impact and Cost Effectiveness of Oral Nutritional Supplements (ONS)
Matthias Pirlich, MD

Sarcopenia and Sarcopenic Obesity: A Modern Scourge for the Older Adult
Tommy Cederholm, MD, PhD

Chronic Intestinal Failure: A New Definition? (Clinical Nutrition 2015) and New ESPEN Guidelines
André Van Gossum, MD, PhD

LEARNING LEVEL: Advanced
UAN: 0216-0000-17-032-L04-P
CE CREDIT: 1.5 hours

Contributed by the European Society for Clinical Nutrition and Metabolism (ESPEN)

Protein, Muscle, and ICU Outcomes

LEARNING OBJECTIVES
1. Describe the nutritional approach to limit muscle wasting in the ICU
2. Analyze the effect of nutrition therapy on protein turnover in critically ill patients
3. Implement enhanced protein delivery in patients to improve ICU survivor outcomes

FACULTY & TOPICS
Nutritional Modifications to Limit Muscle Wasting
Danielle Bear, RD

Protein Intake and Promotion of Anabolism
Sadeq A. Quraishi, MD

Improved ICU Survivor Outcomes with Increased Protein Delivery
Peter Weijs, PhD

Protein Requirements in ECMO and CRRT
Elisabeth DeWael, MD, PhD

MODERATOR: Kenneth Christopher, MD
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-033-L04-P
CE CREDIT: 1.5 hours

Exocrine Pancreatic Insufficiency in Pediatric and Adult Populations 

LEARNING OBJECTIVES
1. Describe normal physiology of the pancreas and consequences of exocrine pancreatic enzyme deficiency on digestion, including differences between pediatric and adult patients
2. List several causes of exocrine pancreatic insufficiency in different age groups from infants to geriatric patients
3. Discuss the indications, contraindications, and complications of pancreatic enzyme replacement therapy (PERT)
4. Explain factors affecting dose and product selection for PERT, and appropriate administration precautions during altered nutrient intake and feeding routes (oral, gastric tube, jejunal tube)

FACULTY & TOPICS
Pancreatic Physiology and the Consequences of Exocrine Pancreatic Enzyme Deficiency
Molly Bozic, MD

Pancreatic Enzyme Replacement Therapy (PERT)
Sara Bliss, PharmD, BCPS, BCNSP

MODERATOR: Carol Rollins, MS, RD, PharmD, CNSC,BCNSP, FASPEN
LEARNING LEVEL: Basic
UAN: 0216-0000-17-034-L04-P
CE CREDIT: 1.5 hours

Healthcare Economics for the Nutrition Support Professional

LEARNING OBJECTIVES
1. Define common terms and concepts used in health care economics using examples from nutrition support related research projects
2. Demonstrate how improved coding for malnutrition can increase reimbursement
3. Understand approaches to integrating improvements in health services delivery and costs of care to establish the value of nutrition support interventions

FACULTY & TOPICS
Health Care Economics Terminology and Concepts
Meredith Kilgore, RN, PhD

Improved Reimbursement from Improved Coding for Malnutrition
Louise Merriman, MS, RD, CDN

MODERATOR: Cynthia Hamilton, MS, RD, LD, FAND
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-035-L04-P
CE CREDIT: 1.5 hours

Roundtables

DESCRIPTION
Discuss specific nutrition support topics during the Roundtables. Tables will be organized by topic and participants will have an opportunity to discuss in groups with the faculty. Each faculty member will meet with groups for 25 minutes before participants are asked to move to another table for discussion on a different topic. Participants will have an opportunity to visit three topics during the session.

    A. THE IMPORTANCE OF GOOD NUTRITION IN CHILDREN WITH MEDICAL COMPLEXITY

LEARNING OBJECTIVES
1. List three benefits of optimizing nutrition in children with medical complexity
2. Discuss the role of different feeding techniques and enteral supports
3. Identify the secondary health conditions that may impact a nutrition care plan

Gina Rempel, MD, FRCPC, FAAP

    B. ASSESSING AND FEEDING A TRANSGENDER PATIENT

LEARNING OBJECTIVES
1. Identify resources and references for future use in the nutrition assessment of transgender individuals
2. Appropriately calculate calorie and protein needs in transgender individuals

Mary Turon-Findley, MS, RD, LD
Raymond Troy, MD

    C. MANAGING COMPLEX GI PATIENTS WITH FODMAPS

LEARNING OBJECTIVES
1. Evaluate the science behind the low FODMAP diet
2. Describe the practical application of the 3 phase low FODMAP diet in IBS, elimination, re-introduction, and maintenance phases
3. Identify the potential application of the low FODMAP in SBS, IBD, SIBO, FI,
and nutrition support patients

Kate Scarlata, RDN, LDN
Carol Ireton-Jones, PhD, RDN, LD, CNSC, FACN, FASPEN

    D. PEDIATRIC NUTRITION MANAGEMENT OF THE TRANSPLANT PATIENT: A FOCUS ON POST-OPERATIVE FEEDING COMPLICATIONS

LEARNING OBJECTIVES
1. Identify common nutrition/GI complications among pediatric solid organ transplant patients (liver, kidney, heart, lung)
2. Explore alternative feeding options(EN vs PN) and formula types
3. Review complicated case studies in the post-operative pediatric transplant patient

Stacey Beer, MPH, RD, LD
Molly Vega, MS, RD, LD

    E. RETHINKING THE ABRIDGED PATIENT–GENERATED SUBJECTIVE GLOBAL ASSESSMENT (APG-SGA) IN THE NUTRITION ASSESSMENT OF ADULT ONCOLOGY PATIENTS IN THE ERA OF SARCOPENIC OBESITY

LEARNING OBJECTIVES
1. Articulate the value of adding CT imaging to determine body composition in adult advanced oncology patients

Pankaj Vashi, MD
Sharon Day, RD, CSO, CNSC

    F. KETOGENIC THERAPY–IMPLICATIONS FOR GUT MILIEU, METABOLIC AND NEUROLOGIC HEALTH, AND DIET QUALITY

LEARNING OBJECTIVES
1. List biochemical and hormonal changes associated with ketogenic metabolism
2. Identify the potential impact of ketogenic therapy on glucose and lipid metabolism and inflammation
3. Identify specific dietary factors associated with gastrointestinal health and describe implications for neurologic health

Kelly Roehl, MS, RD, CNSC, LDN
Heather Rasmussen, PhD, RD

    G. REFEEDING SYNDROME – WHAT YOU NEED TO KNOW

LEARNING OBJECTIVES
1. Identify patients at risk for refeeding syndrome
2. Develop a plan and recommendations for nutrition therapy to monitor for and ideally prevent refeeding syndrome

Kim Sabino, MS, RD, CNSC

    H. CLINICIAN’S GUIDE FOR BLENDERIZED DIETS

LEARNING OBJECTIVES
1. Construct sample recipes for patients
2. Discuss perceived clinical barriers to BTF

Lisa Epp, RDN, LD, CNSC

    I. PREVENTING AND MANAGING ANEMIA IN PEOPLE WITH INTESTINAL MALABSORPTION

LEARNING OBJECTIVES
1. List three clinical signs of anemia
2. Differentiate between absolute iron deficiency, functional iron deficiency, and anemia of chronic illness
3. List two oral and two parenteral strategies for managing both iron deficiency and B12 deficiency and explain when oral repletion is and is not appropriate

Sara Bonnes, MD

    J. PROPER GLYCEMIC MANAGEMENT IN PATIENTS RECEIVING NUTRITION SUPPORT THERAPY

LEARNING OBJECTIVES
1. Identify patient-specific factors that will alter the management in patients receiving parenteral and enteral nutrition
2. Develop strategies for safe management of hyperglycemia in patients receiving nutrition support therapy
3. Select effective interventions to successfully manage hyperglycemia in patients receiving nutrition support therapy

Andrew Mays, PharmD
Phil Ayers, PharmD, BCNSP, FASHP

LEARNING LEVEL: Basic for all Roundtables
UAN: No pharmacy credit
CE CREDIT: 1.5 full session (3 roundtables)

Noncompliance in Nutrition Support

LEARNING OBJECTIVES
1. List the potential areas of noncompliance
2. Discuss the legal obligations and options with patients who are exhibiting noncompliance
3. Discuss the indications, contraindications, and complications of pancreatic enzyme replacement therapy (PERT)
4. Evaluate the complexities of severing a relationship with a noncompliant patient

FACULTY & TOPICS
Noncompliance in Nutrition support - Overview
Donald F. Kirby, MD, FACP, FACN, FACG, AGAF, CNSC, CPNS

Understanding Both Clinician’s and Patient’s Issues with Noncompliance
NaSheema Anderson, BS

Home Care Perspective of Noncompliance in Pediatric and Adult Patients
Eileen Hendrickson, PharmD, MBA

MODERATOR: Donald F. Kirby, MD, FACP, FACN, FACG, AGAF, CNSC, CPNS
LEARNING LEVEL: Intermediate
UAN: 0216-0000-17-036-L04-P
CE CREDIT: 1.5 hours