Overview
Collaborative Management Strategies for Acute/Urgent Care in Short Bowel Syndrome
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Patients with short bowel syndrome (SBS) may present in an acute care setting for many reasons, including diarrhea, dehydration, bowel obstruction, gallstones, and complications related to parenteral nutrition (PN) such as infections. In this Clinical Commentary video with accompanying downloadable infographic, physicians, nurses, NPs, and PAs within the urgent care and emergency department settings will learn about SBS, common complications, and strategies for reducing the risk of future complications, including pharmacologic options for enhancing intestinal adaptation that can lead to meaningful reductions in PN requirements, thereby reducing the incidence of PN-related complications in patients with SBS.
This activity is intended for NPs, PAs, nurses, and other clinicians practicing in an urgent care or emergency room setting.
Short bowel syndrome (SBS) is a malabsorptive condition that can occur after resection of portions of the small intestine that results in the inability to maintain appropriate homeostasis in electrolyte balance, fluid absorption, and nutritional intake, leading to significant impacts on quality of life and overall morbidity and mortality. Dietary therapy is the most crucial aspect of care for patients with SBS as both a primary life-sustaining intervention and also a mechanism for rehabilitating the remaining bowel; this includes not only careful management of enteral intake but also individualized PN when needed. Similarly, oral fluid therapy and careful assessment of hydration status are also essential, and the needs of an individual patient often vary according to which portions of the bowel remain. However, management of SBS is highly complex and is associated with a wide variety of common complications that may lead patients to present in an urgent care or emergency setting, including diarrhea, dehydration, bowel obstruction, gallstones, and GI bleeding. In addition, complications related to parenteral nutrition (PN) such as infections, occlusion, and breakage also commonly occur and cause patients to present for emergency care. Clinicians in the urgent care or emergency room setting have an opportunity to counsel patients and caregivers on strategies to reduce the incidence of SBS-related complications as well as those complications related to PN. Although appropriate catheter care is an important point of emphasis, long-term options to decrease the risk of PN-related complications through reduction or elimination of the need for PN could be even more meaningful. As such, clinicians within the urgent care and emergency department settings can provide insights on PN weaning at point-of-care and triage patients to specialty care. Educating patients about options for PN weaning, including intestinotrophic agents such as teduglutide, could lead to meaningful reductions in PN requirements that would, in turn, reduce the incidence of PN-related complications. To realize this outcome, education of nurses, NPs, and PAs about complications faced by patients with SBS and strategies to address these complications in the acute setting, as well as best practices for referral to specialty care to pursue avenues for PN weaning are critical.
Upon completion of this activity, participants will be able to:
• Describe complications that are associated with parenteral nutrition in patients with SBS
• Identify strategies for preventing complications associated with SBS and parenteral nutrition
• Implement system-based tools and best practices for providing coordinated, multidisciplinary care for patients with SBS during and after emergency care
• Describe complications that are associated with parenteral nutrition in patients with SBS
• Identify strategies for preventing complications associated with SBS and parenteral nutrition
• Implement system-based tools and best practices for providing coordinated, multidisciplinary care for patients with SBS during and after emergency care
Sponsored by Rush University Medical Center and the Academy for Continued Healthcare Learning (ACHL)
Supported by an educational grant from Takeda Pharmaceuticals, U.S.A.
Alyssa Burnham, PA-C
Senior Physician Assistant
Recanati Miller Transplantation Institute
Mount Sinai Hospital
New York, NY
Senior Physician Assistant
Recanati Miller Transplantation Institute
Mount Sinai Hospital
New York, NY
Kishore R. Iyer, MBBS, FRCS, FACS
Professor of Surgery & Pediatrics
Icahn School of Medicine at Mount Sinai
Director, Intestinal Rehab &Transplant Program
Mount Sinai Hospital
New York, NY
Disclosure Policy:
As a provider of continuing education, Rush University Medical Center asks everyone who has the ability to control or influence the content of an educational activity to disclose information about all of their financial relationships with ineligible companies within the prior 24 months. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of the relationship to the education. Mechanisms are in place to identify and mitigate any potential conflicts of interest prior to the start of the activity. All information disclosed must be shared with the participants/learners prior to the start of the educational activity.
The following individual(s) in control of content for this specific activity have the following relevant financial relationships to disclose and all financial relationships have been mitigated:
Kishore R. Iyer, MBBS, FRCS, FACS
Sources of Funding for Research: Shire Pharmaceuticals, VectivBio, Zealand Pharma
Consulting Agreements: Hanmi, Ipsen, Northsea, Takeda Pharmaceuticals, VectivBio
The following faculty have no relevant financial relationships to disclose:
Alyssa Burnham, PA-C
Discussion of Off-Label, Investigational, or Experimental Drug/Device Use: Proton pump inhibitors, histamine type-2 receptor antagonists, clonidine, and codeine are not indicated for the treatment of diarrhea; apraglutide, glepaglutide, and HM15912 are investigational therapies for the treatment of SBS.
ACHL staff members and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.
The content for this activity was developed independently of the ineligible company. All materials are included with permission. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor.
This educational activity was planned and produced in accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education. Recommendations involving clinical medicine in a continuing medical education (CME/CE) activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported, or used in CME/CE in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, and analysis.
Unapproved Uses of Drugs/Devices: In accordance with requirements of the FDA, the audience is advised that information presented in this continuing medical education activity may contain references to unlabeled or unapproved uses of drugs or devices. Please refer to the FDA approved package insert for each drug/device for full prescribing/utilization information.
This activity will take approximately 60 minutes to complete. To receive credit, participants are required to complete the pretest, view the online activity and complete the posttest and evaluation. To receive credit, 75% must be achieved on the posttest. A certificate will be immediately available. There is no fee to participate in the activity or for the generation of the certificate.
For questions, contact Katie Hacias at khacias@achlcme.org
Rush University Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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Rush University Medical Center designates this internet enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Rush University Medical Center designates this internet enduring material for a maximum of 1.0 nursing contact hour.

This activity has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Approval is valid from 10/31/2022 to 10/31/2023. AAPA reference number: CME-208120.
This activity is approved for 0.85 contact hour(s) of continuing education (which includes 0 hour(s) of pharmacology) by the American Association of Nurse Practitioners®. Activity ID# 22105819. This activity was planned in accordance with AANP Accreditation Standards and Policies.