Hospital Pharmacy - July/August 2018 - 240

240
have multiple board certifications. The duration of individual practice experience of the group members ranges
from 3 years to more than 30 years post-training. Members
of this authorship group have advanced practice roles with
direct patient care responsibilities for prescribing parenteral
nutrition (PN) and/or enteral nutrition (EN), laboratory
analysis, and pharmacotherapy integrated with nutrition
therapy (eg, fluid and electrolytes, vitamins, trace elements, prokinetic drugs, insulin, antidiarrheal and laxative
therapy), and some have administrative or supervisory
roles with respect to nutrition support therapy. This authorship group has a broad range of practice experiences. Most
authors are acute care-based, but some have long-term
care (home PN and EN) responsibilities. Current practices
of the group range from pediatrics to geriatrics. Some members have a diverse patient population, whereas others practice within a focused patient population (e.g., pediatrics,
oncology, trauma/thermal injury).
The author participants were asked to by the principal
author (R.N.D.) to provide citations of articles published
from January 2017 to December 2017 that they have personally accumulated which resulted in a change or affirmation
of their current clinical practice or that they considered to be
important for future clinical practice. Only those articles
available in print format were allowed for potential inclusion. Articles available only in preprint electronic format
(with intention of publication by the journal in 2018 or later)
were not evaluated. The citation list was compiled into a
spreadsheet where the author participants were asked to
denote whether the article was considered important to pharmacy nutrition support practice. An abstract and complete
citation of each article was provided along with the electronic scoring spreadsheet to assist the author participants
with the evaluation process. To ensure an independent voting
process without influence from the other participant members, only the principal author participant was aware of others' rankings. To prevent influence from the other author
participants on the principal author, scoring of all the articles
by the principal author was completed prior to review of the
results from the other contributors. The votes were tallied.
The article was considered important if at least 5 out of 8
participants voted for an article to be of high priority in its
relevance to pharmacy nutrition support practice. From this
scoring system, a culled list of the most important articles
was created.

Results
A total of 95 articles were collectively collated for initial
evaluation by the authorship group. Eighty-two articles
were from the primary literature and scored by the authorship group. An average of 17 articles (range: 9-25) were
denoted as significant by individual members of the author
group. According to a majority consensus vote, 6 articles
from the primary literature collective were identified as

Hospital Pharmacy 53(4)
most important for pharmacy nutrition support practice
(Table 1). One additional article, that received 4 votes, was
included in Table 1 but was not critically evaluated because
a majority consensus was not achieved. An additional 13
articles comprising of organizational guidelines, consensus, recommendation, and position papers were not evaluated or scored but were automatically included separately
as important articles to our practice. Of these 20 finalist
publications, 6 were published in Journal of Parenteral and
Enteral Nutrition, 5 were from Clinical Nutrition, and 3
were published in Nutrition in Clinical Practice. The
remaining 6 articles were from 5 different journals. Individual rankings, based on relevancy to pharmacy nutrition
support clinical practice according to the author participant
group, are given in Table 1. The finalist articles from the
primary literature are summarized in the discussion along
with a narrative regarding their implications for pharmacy
nutrition support practice. A narrative regarding guidelines,
position, recommendation, and consensus papers was not
provided but are listed in Table 2. All remaining citations
from the primary literature individually received ≤3 votes
as significant by the group and are provided in an online
supplement.

Discussion
1.

Compher et al: Greater protein and energy intake
may be associated with improved mortality in higher
risk critically ill patients: a multicenter, multinational
observational study.5

The optimal protein and energy dose in critically ill patients
remains controversial due to conflicting study results. It
has been suggested that critically ill patients at higher
nutrition risk are more likely to benefit from enhanced
delivery of protein and energy and the NUTrition Risk in
the Critically Ill (NUTRIC) score has been designed to
help identify these patients. This observational study
aimed to determine whether protein or energy intake interacts with high versus low NUTRIC scores to impact 60-day
mortality or time to discharge alive (TDA). Data were
taken from the International Nutrition Survey 2013 database, previously used to evaluate the impact of prescribed
protein on mortality and TDA.25 The study included
patients in the intensive care unit (ICU) for at least 4 days
(n = 2853), with subset analysis of those patients who
remained in the ICU for at least 12 days (n = 1636).
Interleukin-6 (IL-6) was unavailable and was omitted from
the NUTRIC score. The NUTRIC scores ≥5 were considered high nutrition risk, while patients with scores <5 were
considered low risk. The majority (about two-thirds) of
patients were medical ICU and the mean NUTRIC score
was 4.8 in both samples.
In the 4-day sample, protein and energy intake did not
significantly interact with NUTRIC category in mortality

Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2018