Gordon Sacks

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Dr. Sacks earned a Doctorate of Pharmacy degree from the University of Texas (1994) after receiving his BS degree in Pharmacy from Auburn University (1989). He has completed a Pharmacy Practice Residency at Huntsville Hospital and a 2-year Nutrition Support Fellowship at the University of Tennessee, Memphis. During his tenure at the University of Mississippi (1995-2001), he achieved the rank of Associate Professor of Pharmacy Practice and was Coordinator of the Nutrition Support Team at University of Mississippi Medical Center, Jackson. Between 2001-2008, he was a Clinical Professor at the University of Wisconsin – Madison and Chair of the Pharmacy Practice Division in the School of Pharmacy. He was also Coordinator of the Surgical Nutrition Support Team at the University of Wisconsin Hospital and Clinics in Madison, WI. Starting in January, 2009, Dr. Sacks became Department Head of Pharmacy Practice at the Harrison School of Pharmacy at Auburn University, Auburn, Alabama. He has been a board-certified Nutrition Support Pharmacist since 1995. Dr. Sacks is active in numerous scientific and professional societies. He was recently the President of the American Society for Parenteral and Enteral Nutrition (ASPEN) from July 2015 – June 2016.

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Manipal Academy of Higher Education

Salwa AlDahlawi

Umm Al-Qura University, Makkah, Saudi Arabia

Praveen Arany

University at Buffalo, State University of New York

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Universidad de Buenos Aires

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UBC

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Peter Mandl

Medical University of Vienna

Harvey Farberman

SUNY: Stony Brook University

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Papers by Gordon Sacks

The Shrinking of Formalized Nutrition Education in Health Professions Curricula and Postgraduate Training

Journal of Parenteral and Enteral Nutrition

The quantity of formalized nutrition education is shrinking in curricula of health professions, s... more The quantity of formalized nutrition education is shrinking in curricula of health professions, such as physicians, nurses, dietitians, and pharmacists. The current nutrition education being taught in U.S. schools of healthcare professionals does not appropriately prepare students for identification of patients at nutrition risk or management of undernourished hospitalized patients with specialized nutrition therapies. In U.S. schools of pharmacy, parenteral nutrition is considered a highly specialized and advanced practice so little time is devoted to this area and more attention is focused on chronic disease state management (ie, hypertension, diabetes mellitus, and congestive heart failure). Nutrition support fellowships for physicians and nutrition support residency programs for pharmacists have dwindled in number over the years so that only a handful of these healthcare professionals are produced each year from the remaining formalized programs. Physicians, nurses, pharmacists, and dietitians can positively affect patient care, but each profession must first determine how best to integrate basic and applied nutrition concepts into their professional curricula and training programs. There must also be consensus among the healthcare professions as to the depth of nutrition education and the stage of training at which these integrations should occur. Only by having these crucial conversations among all disciplines will we be able to develop new strategies to expand nutrition education in the training of future medical practitioners.

Observations of Hypophosphatemia and Its Management in Nutrition Support

Nutrition in Clinical Practice

Severe hypophosphatemia is associated with significant morbidity in hospitalized patients. Specia... more Severe hypophosphatemia is associated with significant morbidity in hospitalized patients. Specialized nutrition support is an important factor that contributes to the development of this metabolic disorder. Current treatment regimens for hypophosphatemia are empiric and often fail to normalize serum phosphorus concentrations in these patients. Patients who develop hypophosphatemia during the administration of specialized nutrition support exhibit increased phosphorus demands and require aggressive replacement therapy.

Nutrition in Aging

Brocklehurst's Textbook of Geriatric Medicine and Gerontology, 2010

Mononuclear blood cell magnesium content and serum magnesium concentration in critically ill hypomagnesemic patients after replacement therapy*1

Nutrition, 1997

Magnesium (Mg) deficiency, commonly diagnosed as hypomagnesemia based upon low serum Mg concentra... more Magnesium (Mg) deficiency, commonly diagnosed as hypomagnesemia based upon low serum Mg concentrations, is a frequent electrolyte abnormality in critically ill patients. Intravenous replacement therapy is empiric and serum Mg concentrations have traditionally been used as guidelines for measuring efficacy. Recent studies have shown that the Mg content of mononuclear blood cells (MBCs) may provide a better index for Mg status than serum concentrations. The purpose of this study was to evaluate the effects of intravenous Mg replacement therapy on MBC Mg content and serum Mg concentrations in critically ill hypomagnesemic patients. Adult patients admitted to the trauma intensive-care unit (ICU) with serum Mg concentration &lt; or = 0.6 mmol/L (&lt; or = 1.5 mg/dL) were considered for study entry. Patients with severe renal disease (Scr &gt; 133 mumol/L), pregnancy, or those who were seropositive for HIV were excluded. Ten patients with moderate (&gt; 0.4-0.6 mmol/L [&gt; 1.0-1.5 mg/dL]) and severe (&lt; or = 0.4 mmol/L [&lt; or = 1.0 mg/dL]) hypomagnesemia received 0.5 and 0.75 mmol/kg of intravenous MgSO4, respectively, over 24 h. MBC Mg content and serum concentrations of magnesium, phosphorus, calcium, sodium, potassium, blood urea nitrogen, creatinine, glucose, and albumin were measured at baseline (0 h), end of infusion (24 h), 36 h, and 48 h. Data were analyzed using ANOVA with repeated measures and a P value &lt; 0.05 was considered significant. Serum Mg concentrations increased significantly from baseline to 48 h (0.5 +/- 0.1 to 0.8 +/- 0.2 mmol/L, P &lt; 0.001). MBC Mg content did not change significantly within the study period (2.6 +/- 1.0 to 3.0 +/- 1.3 fmol/cell, P &gt; 0.7). The doses of MgSO4 (0.5-0.75 mmol/kg) used in this study increased serum Mg concentrations, but did not result in a statistically significant change of MBC Mg content in this group of trauma ICU patients.

Approaches to management of dilemmas by leaders in academic pharmacy

Currents in Pharmacy Teaching and Learning, 2012

Abstract In 1984, Bolman and Deal introduced the theory of frames as organizational strategies al... more Abstract In 1984, Bolman and Deal introduced the theory of frames as organizational strategies allowing one to examine dilemmas from multiple vantage points. These four frames, identified as structural, human resource, political, and symbolic, enrich and broaden a leader's options for solving problems. The objective of this project was to identify preferred strategies used by academic pharmacy leaders for resolving dilemmas in the context of the four frames of leadership. Current Deans of schools/colleges of pharmacy who have participated in the AACP Academic Leaders Fellowship Program as participants or facilitators were asked to complete an online survey. The survey instrument consisted of a tenure/promotion case with three brief scenarios involving different types of dilemmas pertinent to the case. The instrument was designed to address the four frames. The first scenario, which dealt with a faculty member being assigned additional research and administrative responsibilities, revealed that Deans tended to rely on the structural, human resources, and symbolic frames when making decisions about this dilemma. The second scenario, dealing with a faculty member with poor teaching evaluations, indicated that Deans operated within all four frames; however, the human resources and symbolic frames were slightly more dominant. The final scenario, which dealt with a suspected inappropriate faculty-student relationship, demonstrated that Deans felt confidential information should not be considered when making decisions regarding promotion and tenure. Although studies have shown that most people rely on the structural and human resource frames, it appears that pharmacy Deans use all four frames when making decisions regarding academic dilemmas.

P223 Continuous Feeding with a Diabetes-Specific Formula Improves Glycemic Variability and Reduces Insulin Requirements in Tube Fed Patients with Type 2 Diabetes Managed with Insulin

Clinical Nutrition Supplements, 2009

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Glutamine supplementation in catabolic patients

Annals of Pharmacotherapy, 1999

OBJECTIVE: To evaluate the safety and efficacy of parenteral and enteral glutamine supplementatio... more OBJECTIVE: To evaluate the safety and efficacy of parenteral and enteral glutamine supplementation in patients who are catabolic. DATA SOURCES: English-language clinical trials and review articles identified by MEDLINE searches (January 1970–December 1997) and from bibliographies of selected articles were considered for possible inclusion. Key words used in the search strategy were glutamine, critical illness, stress, catabolism, injury, enteral nutrition, and parenteral nutrition. STUDY SELECTION AND DATA EXTRACTION: Inclusion was restricted to pertinent studies that evaluated the safety of glutamine supplementation, as well as effects of glutamine on amino acid metabolism, immune function, and patient outcome. Data from 18 clinical trials and multiple review articles were compiled into a review format. DATA SYNTHESIS: Glutamine is an important metabolic fuel for intestinal enterocytes, lymphocytes and macrophages, and metabolic precursors such as purines and pyrimidines. Although ...

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Update to A.S.P.E.N. position paper: clinical role for alternative intravenous fat emulsions

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2014

Fatty acids (FAs) are categorized based on several different characteristics. First is the number... more Fatty acids (FAs) are categorized based on several different characteristics. First is the number of carbons in the FA chain: 2-4 carbons, short-chain FA; 6-12 carbons, medium-chain FA; and ≥14 carbons, long-chain FA. Second is the number of double bonds in the FA molecule. Saturated FAs have no double bonds, monounsaturated FAs (MUFA) have 1 double bond, and polyunsaturated FAs (PUFAs) have 2 or more double bonds. Also, unsaturated FAs are categorized according to which carbon atom in the chain the first double bond occurs, counting from the methyl end of the molecule, which is referred to as the ω carbon. There are 3 principal families of unsaturated FAs in humans-ω-3, ω-6, and ω-9-in which the first double bond occurs at the third carbon, sixth carbon, or ninth carbon, respectively. 1 The nomenclature for FA is X:Y ω-Z, where X is the number of carbons in the FA chain, Y is the number of double bonds, and, for unsaturated FAs, Z is the number of carbons from the ω carbon where the first double bond occurs. Numerous abbreviations are used throughout this position paper. Table summarizes these frequently used abbreviations. The ω-6 and ω-3 FAs are metabolized through 2 different pathways but use the same enzymes with a preference of ω-3 > ω-6 > ω-9 (Figure ). Although individual immune function tests may show variable results, clinically, ω-3 FAs are relatively less proinflammatory than ω-6 FAs. In addition, some ω-3 FAs may actually have anti-inflammatory effects (Figure ). These 2 metabolic pathways use and compete for the same enzymes. However, more of 1 FA than another in the diet, and thus in tissue membranes, can drive the process more to the proinflammatory metabolites or to the anti-inflammatory metabolites. Some evidence suggests that certain long-chain FAs may impair immune function by interfering with phagocytosis and chemotaxis and may result in an increased risk of infection. 1 896N CPXXX10.1177/0884533612439896A.S.P.

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Parenteral Nutrition Safety: The Story Continues

Nutrition in Clinical Practice

The Effect of Higher Protein Dosing in Critically Ill Patients: A Multicenter Registry-Based Randomized Trial: The EFFORT Trial

Journal of Parenteral and Enteral Nutrition

Taurine supplementation at three different dosages and its effect on trauma patients JD PAAUW, AT DAVIS Michigan State University, Butterworth Hospital, Grand Rapids, Michigan

Nutrition in Clinical Practice

Lipid Injectable Emulsion Survey With Gap Analysis

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2017

Lipid injectable emulsion (ILE) is an integral part of parenteral nutrition (PN), providing energ... more Lipid injectable emulsion (ILE) is an integral part of parenteral nutrition (PN), providing energy and essential fatty acids. With recent consensus recommendations for PN, clinical guidelines for ordering and preparation of PN, the U.S. Food and Drug Administration approval of new ILE products, and revised ILE labeling to include a 1.2-micron filter, a gap in current practice knowledge was apparent. The American Society for Parenteral and Enteral Nutrition PN Safety Committee surveyed clinicians on how ILE products are prescribed, prepared, and administered to patients from neonates to adults. The results of this survey conducted in late 2016 found a wide variation in practice, particularly across patient age groups. These findings demonstrate the need for ongoing dissemination and education on standardized safe practices for ILE use.

Tributes to Daniel H. Teitelbaum, MD, PhD

Journal of Parenteral and Enteral Nutrition, 2016

was truly a stellar leader, a gifted investigator and mentor, a global diplomat, and a dedicated ... more

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Oral delivery formulations of L-glutamine

Compounding parenteral nutrition: reducing the risks

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

Compounding parenteral nutrition, either manually or with an automated compounding device, requir... more Compounding parenteral nutrition, either manually or with an automated compounding device, requires aseptic conditions and trained personnel. The revised version of United States Pharmacopeia Chapter <797> is a comprehensive document that describes standards and procedures to minimize the risk of contamination of compounded parenteral products. The chapter includes evidence-based instructions for pharmacy design, washing, garbing, cleaning, quality assurance, and personnel training and evaluation designed to improve compounding practices in all pharmacies that compound parenteral products. Because parenteral nutrition is a compounded product mixed from multiple additives, it is important to maintain these standards, especially when using an automated compounding device. This article is an overview of United States Pharmacopeia Chapter <797>, with special emphasis on parenteral nutrition.

Uncertainty about the safety of supplemental glutamine: an editorial on "A randomized trial of glutamine and antioxidants in critically ill patients

Hepatobiliary surgery and nutrition, 2015

Previously small randomized clinical trials and several meta-analyses have suggested improved pat... more Previously small randomized clinical trials and several meta-analyses have suggested improved patient outcomes from parenteral glutamine supplementation. A recent large multi-center randomized trial conducted in critically ill patients with documented multiple organ failure at enrollment demonstrated an increase in mortality among those receiving supplemental glutamine. This article discusses the discrepancies in trial outcomes and the risks associated with glutamine administration during critical illness.

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The ABC's of Acid-Base Balance

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2004

A step-wise systematic approach can be used to determine the etiology and proper management of ac... more A step-wise systematic approach can be used to determine the etiology and proper management of acid-base disorders. The objectives of this article are to: (1) discuss the physiologic processes involved in acid-base disturbances, (2) identify primary and secondary acid-base disturbances based upon arterial blood gas and laboratory measurements, (3) utilize the anion gap for diagnostic purposes, and (4) outline a stepwise approach for interpretation and treatment of acid-base disorders. Case studies are used to illustrate the application of the discussed systematic approach.

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Effect of glutamine-supplemented parenteral nutrition on mortality in critically ill patients

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2011

Glutamine is recognized as a critical amino acid involved in immunity, intestinal health, and nit... more Glutamine is recognized as a critical amino acid involved in immunity, intestinal health, and nitrogen transport between organs. Prior to the pivotal study by Griffiths and colleagues in 1997, no clinical trials had demonstrated a positive effect from glutamine supplementation on improving long-term survival in critically ill intensive care unit patients receiving parenteral nutrition. Subsequent investigations have confirmed these findings, but further data are needed to determine the optimal dose and timing of glutamine as well as the form of glutamine (ie, free vs dipeptide) that produces the most significant improvement in outcome parameters.

Micronutrients and older adults

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

The aging population worldwide is increasing. Although many older adults are living longer, healt... more The aging population worldwide is increasing. Although many older adults are living longer, healthier lives, aging is also associated with a variety of physiologic and psychological changes that influence nutrition status and the need for medical care. Many factors increase the risk for poor nutrient intake among older adults. Suboptimal micronutrient intake for particular vitamins and minerals is reported to be common.

Refeeding syndrome: awareness is the first step in preventing complications

The journal of supportive oncology

The Shrinking of Formalized Nutrition Education in Health Professions Curricula and Postgraduate Training

Journal of Parenteral and Enteral Nutrition