Mentoring Handbook

Overview

Mentoring is an intentional relationship structured for a specific length of time around mutually agreed upon goals. The act of mentoring dates back to early Greek mythology. As Ulysses was leaving to fight in the Trojan War, he leaves his infant son, Telemachus, in the hands of a loyal friend and advisor, Mentor. Throughout the next 20 years, Mentor guided Telemachus in his education, character and wisdom until his father returns home. Mentoring today is synonymous with the process by which we watch over and guide others.

Mentoring is a two-way relationship; both you and your mentor will benefit from the experience. Benefits you and your mentor may receive from mentoring include improved performance and productivity, enhanced knowledge and skills, and greater confidence. Additional benefits of having a mentor include:

Individual recognition, encouragement, and support Increased confidence when dealing with other health professionals Confidence to challenge oneself to achieve new goals and explore alternatives Indoctrination to networking Further career opportunity and advancement

While the benefits of being a mentor include: Satisfaction of helping a mentee reach academic and professional goals Recognition at work for participation An expanded network of professional colleagues Recognition for service to the community Increased self-esteem, self-confidence and affirmation of professional competence

As a member of the Dietitians in Nutrition Support Practice group you have the opportunity to establish a mentoring relationship (Please see Appendix A for both the mentee and mentor applications). DNS Mentorship Program serves to connect members with highly qualified mentors in order to advance the practice of nutrition support in all health care settings and to build relationships that foster future leadership opportunities within DNS. The goal of the DNS Mentoring Program is to connect members with highly qualified mentors to advance the practice of nutrition support in all health care settings. The objectives of the DNS Mentoring Program include:

1. To enhance knowledge and skills of DNS members in the practice of nutrition support via one-on-one partnership with a qualified mentor

2. To empower DNS Mentoring Program mentees to initiate or increase research opportunities within individual practice settings

3. To facilitate networking opportunities nationally to increase perspectives of different nutrition support practices among DNS Mentoring Program mentors and mentees

Understanding your role and responsibilities within the mentor/mentee relationship will better enable you to reach all of your desired goals. The four steps outlined in Table One are important phases in the mentoring process: identify roles, establish expectations, collaboration and complete specific goals.

Table One: Summary of the four phases of the mentoring processStep 1: Identify Roles

Mentee MenteeHave a clear understanding of why you want to be mentor

Mentor with a realistic assessment of your skills and experience

Phase 2: Establish ExpectationsMentee Mentee

Have a clear understanding of your expectations for your mentor

Have a clear understanding of your expectations for your mentee

Clearly communicate expectations Clearly communicate expectationsStay flexible in changing expectations or plans Stay flexible in changing expectations or plansCreate goals with milestones and deliverables Adapt your feedback to your mentee’s

learning styleInform your mentor about your preferred learning styleBe realistic about setting timelinesPhase 3: Collaboration

Mentee MenteeListen and contribute to the conversation Advise, do not dictateUnderstand that your mentor will not have all the answers

Advise on what you know and admit the things you don’t know

Accept constructive feedback Offer constructive feedbackSet time aside for self-reflection Give good examplesEvaluate progress Recognize your mentee’s weaknesses and

build on his/her strengthsCelebrate success Evaluate progressBe consistent and reliable Be your mentee’s supporter when he/she

reaches his/her goalsBe consistent and reliable

Phase 4: Complete Specific GoalsMentee Mentee

Provide your mentor with updates Congratulate mentee for completing goalsExpress your gratitude Repeat the mentoring process with othersGive back to the profession and volunteer to become a mentor

Step 1: Identify Roles

A mentoring relationship changes over time as the mentor and mentee grow, learn and gain experience from the relationship. As a mentee, have a clear understanding of why you want to be mentor. The following are some important mentee roles:

Driver of Relationship: Identify the skills, knowledge, and goals that you want to achieve Development Planner: Maintain a mentoring plan and work with your mentor to set up

goals, developmental activities, and time frames Resource Partner: Work with your mentor to seek resources for learning; identify people

and information that might be helpful Teacher: Look for opportunities to give back to your mentor; share any information that

you think might be valuable Continuous Learner: Take full advantage of this opportunity to learn

Avoid these common pitfalls: Do not expect your mentor to give you all the answers Do not rely on your mentor as your only source of information Meet deadlines, by meeting goals your mentor will be more receptive Be respectful of your mentors time

As a mentor, your primary role is to provide guidance and support to your mentee based on his or her unique developmental needs. Plan to guide with a realistic assessment of your skills and experience. The following are some important mentor roles:

Coach/Advisor: Give advice and guidance, share ideas, and provide feedback Source of Encouragement/Support: Act as sounding board for ideas/concerns and

provide support on personal issues if appropriate Resource Person: Identify resources to help mentee enhance personal development and

career growth and expand the mentee's network of contacts Champion: Serve as advocate for mentee whenever opportunity presents itself Challenge constructively: When appropriate, play devil's advocate to help mentee think

through important decisions and strategies.Avoid these common pitfalls:

Do not give advice unless it is elicited Encourage independence, not dependence Do not take responsibility for your mentees goals Do not complain about your own problems

Mentoring is not supervision. As a general guideline, a mentor should not: Take the lead in the relationship, setting up all meetings and driving the mentee’s career

development Spend more time on the relationship then he or she is willing or able to give Continue the mentoring relationship if the mentee does not meet expectations

Phase 2: Establish Expectations

Participating in a mentoring relationship is a privilege for both participants, and as a result it is important to be gracious and thoughtful towards each other. Mentors and mentees may enter their relationship with assumed expectations of each other; doing so could result in irritation and disappointment because expectations were not discussed. Please refer to Table Two to identify appropriate mentoring expectations

Table Two: Mentee MentorAccept the relationship on a temporary bases, for approximately 6-18 months

Provide realistic timeframe for achieving mentees goal

Be respectful of your mentor’s schedule, meet as often as your schedule permits

Consider your mentee’s goals, meet as often as necessary to accomplish goals in a timely manner

Establish schedule and best method for communication; keep any commitments made

Establish schedule and best method for communication; keep any commitments made

Take initiate to ask for feedback. Feedback, although difficult to hear at times, is critical to your personal and professional growth and development.

Provide help; serve as a nutrition support broker. Be a sounding board for issues relating to the mentee’s career development

Demonstrate that you are open to hear new ideas and suggestions

Evaluate the relationship at various points

Provide feedback about the mentoring relationship.

Be open to feedback

To prevent frustration and assist in collaboration, establish a clear understanding of your expectation early in the mentoring partnership. The DNS Mentoring Program Contract (Appendix B) will establish the goals, of your mentoring partnership.

It is the responsibility of the mentee to complete the DNS Mentoring Program Contract. The following steps will help you complete the contract:

1. Refer back to the respective mentee/mentor application and look over the “Expectations and Goals/Specialty” section to determine :

a. Your mentor’s expectationsb. Area of specialtyc. Mentor schedule

2. Create specific goal/s you would like to accomplish and identify a timeframe for completion3. Draft a contract stating goals, schedule for communication and timeframe4. Send the contract to you mentor for approval

Phase Three: Collaboration

Once the mentee and mentor have finalized the contract, the fun begins! The mentor is not responsible to develop appropriate curriculum to assist the mentee in achieving their respective goals. Curriculum can consist of a variety of mediums including reading lists, power point presentations, or case studies. Example curriculum is available in Appendix C-E. Once the curriculum has been assigned, both the mentee/mentor can create deadlines to streamline and organize efforts. To improve communication, the mentee should prepare agendas for each meeting to organize time and thoughts. Continue to adjust the curriculum to meet all of the mentor’s goals.

As your mentoring relationship develop, review your goals, expectations and timeline. Throughout your relationship periodically review: what has worked and what has been challenging? The best mentoring relationships have open communication and adjust as needs changes. Be willing to communicate and work together.

At the beginning of your relationship, you will probably feed excitement and energy. As time progress and busy work schedules interfere, it becomes easy to procrastinate. If time lapses, you should not feel guilty, just update your mentor. Meetings can be rescheduled, just have the courtesy to give your mentor adequate notification. Do not allow your relationship to dissolve, if you get off-track contact your mentor to get re-focused. If you are too busy to continue in the mentoring relationship, contact your mentor and end the relationship responsibly. If your relationship ends, please contact the mentoring program chair.

Phase Four: Complete Specific Goals

Congratulations! Your relationship was successful and you completed your contract. As a mentee you have hopefully gained self-esteem and workplace recognition. At this time, assess your current status. Would you like to participate in the mentoring program again or move beyond your mentoring connection? You have the option of participating in the program again with the same mentor or changing mentors and practice experience. Alternatively, you can now participate in the role as mentor.

Mentoring gives you the extraordinary opportunity to facilitate a mentee’s professional growth by sharing knowledge you learned through years of experience. While the primary intent of your mentoring role is to challenge the mentee to think in new and different ways, the mentee is not the only one who gains from the arrangement. As a mentor you can enhance your skills, develop and retain talent within the profession and create a legacy.

Summary

A successful mentor/mentee relationship should be fulfilling and beneficial for all involved. The likelihood of success can be optimized by observing all four phases of mentoring: identifying roles, establish expectations, collaboration and complete specific goals. Remember, to have an effective and productive relationship utilize these ten tips:

1. Keep communications open:Mentee: Be up front. Let your mentor know what your goals are and what you hope to take away from the program.Mentor: Help your mentee set realistic expectations. Also, if you know you will be unavailable because of business or personal travel, let them know.2. Offer support:Mentee: Remember that your mentor is there for you, but is only a guide.Mentor: Encourage communication and participation. Help create a solid plan of action.3. Define expectations:Mentee: Review your goals. Make sure your mentor knows what to expect from you.Mentor: Help set up a system to measure achievement.4. Maintain contact:Mentee: Be polite and courteous. Keep up with your e-mails and ask questions.Mentor: Respond to your e-mails. Answer questions and provide advice, resources and guidance when appropriate.5. Be honest:Mentee: Let your mentor know if you don’t understand something or have a differing opinion.Mentor: Be truthful in your evaluations, but also be tactful.6. Actively participate:Mentee: Listen. Ask if you can observe your mentor’s practice if he/she is local.Mentor: Engage in your own learning while you are mentoring, collaborate on projects, ask questions and experiment.7. Be innovative and creative:Mentee: Offer ideas on what activities and exercises you can do together.Mentor: Share your ideas, give advice and be a resource for new ideas.8. Get to know each other:Mentee and Mentor: Remember that people come from diverse backgrounds and experiences. Get to know each other on an individual basis.9. Be reliable and consistent.Mentee and Mentor: The more consistent you are, the more you will be trusted.10. Stay positive!Mentee: Remember that your mentor is offering feedback and not criticizing.Mentor: Recognize the work the mentee has done and the progress made.

Appendix A: Mentoring Program Application

Appendix B: Mentoring Contract

Appendix C: Example Curriculum: Indications for Enteral and Parenteral Nutrition

Example Curriculum: Indications for Enteral and Parenteral NutritionMonth One Indications for Enteral Nutrition

Objectives: Describe circumstances which would require partial or complete feeding via

enteral nutrition instead of PO feeds in a hospital setting Identify specific diseases and condition that usually require some form of

enteral nutrition Describe potential benefit of using enteral nutrition over parenteral

nutrition Explain the benefits of starting early enteral nutrition Identify specific diseases/condition in which timing of enteral nutrition is

critical

References:1. Scolapio, JS. A Review of the Trends in the Use of Enteral and Parenteral

Nutrition Support. Journal of Clinical Gastroenterology. 38(5)403-407. 2. Petrov MS, van Santvoort HC, Besselink MGH, van der Heijden GJMG,

Windsor JA, Gooszen HG. Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: A meta-analysis of randomized trials. Arch Surg. 2008 November 1;143(11):1111-7.

3. Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Critical Care Medicine. 2005;33(1): 213-220.

4. McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutrition in Clinical Practice. 2009; 24: 305-315

5. Chen Y, Peterson SJ. Enteral nutrition formulas: which formula is right for your adult patient? Nutrition in Clinical Practice. 2009; 24: 344-355

6. Worthington M, Cresci G. A better understanding of immune-enhancing formula use in the critically ill. Support Line. 2010; 32: 16.

Month Two Contraindications for Enteral NutritionObjectives: Describe instances in which enteral nutrition is not appropriate to

provide100% of recommended needs and parenteral nutrition must be used

References:1. Melis M, Fichera A, Ferguson MK. Bowel necrosis associated with early

jejunal tube feeding: a complication of postoperative enteral nutrition. Arch Surg. 2006;141(7):701-704.

2. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper

digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med. 2001;29(10):1955-1961.

3. Parekh NR, Seidner DL. Advanced in enteral feeding in the intestinal failure patient. Support Line. 2006; 28: 18.

4. McClave SA, Chang WK. When to feed the patient with gastrointestinal bleeding. Nutrition in Clinical Practice. 2005; 20: 544-550

Month Three Signs of intolerance to enteral nutritionObjectives: Identify common signs and symptoms of enteral nutrition intolerance Interpret and identify laboratory values that call for changes to enteral

nutrition feeding regimen Describe ways to manage and overcome enteral nutrition complications

References:1. McClave SA, Chang WK. Complications of enteral access. Gastrointest

Endosc. 2003;58:739-751.2. MacLaren R: Intolerance to intragastric enteral nutrition in critically ill

patients: Complications and management. Pharmacotherapy 2000; 20: 1486–1498

3. Btaiche IF, Chan LN, Pleva M, Kraft MD. Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutrition in Clinical Practice. 2010; 25: 32-49

Month Four Indications for parenteral nutritionObjectives: Describe circumstances which call for the initiation of parenteral nutrition Explain the potential benefits of combination feeding (simultaneously feeding PN and EN) Identify time periods in which parenteral nutrition should be initiated in various patient populations/disease states

References:1. Heidegger CP, Romand JA, Treggiari MM, et al. Is it now time to promote

mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med. 2007;33(6):963-969.

2. Mirhosseini N, Fainsinger RL, Baracos V. Parenteral Nutrition in Advanced Cancer: Indications and Clinical Practice Guidelines. Journal of Palliative Medicine. 2005, 8(5): 914-918. doi:10.1089/jpm.2005.8.914.

3. Finn K, Radler DR, Brody R, Khan H, Touger-Decker R. Indications for parenteral nutrition: agreement with the American Society for Parenteral and Enteral Nutrition guidelines. Support Line. 2009; 31: 22.

Month Five Contraindications for Parenteral NutritionObjectives: Identify clinical situation in which parenteral nutrition is not indicated to provide nutrient requirements

References:1. Beghetto MG, Victorino J, Teixeira L, de Azevedo MJ. Parenteral

nutrition as a risk factor for central venous catheter-related infection. J Parenter Enteral Nutr. 2005 Sep-Oct;29(5):367-73.

2. Braunschweig C, Liang H, Sheean P. Indications for administration of parenteral nutrition in adults. Nutr Clin Pract. 2004;19(3):255-62.

Month Six Signs of Intolerance to Parenteral NutritionObjectives: Identify common signs and symptoms of parenteral nutrition intolerance Describe circumstances which warrant cautious use of parenteral nutrition Interpret and identify laboratory values that call for changes to parenteral nutrition composition Describe ways to manage and overcome enteral nutrition complications

References:1. Kraft MD, Btaiche IF, Sacks GS. Review of the refeeding syndrome. Nutr

Clin Pract. 2005;20(6):625-633.2. Buchman AL. Complications of long-term total parenteral nutrition: their

identification, prevention and treatment. Dig Dis Sci 2001; 45(1): 1–18.

Appendix D: Example Curriculum: Interpreting Laboratory Values

Example Curriculum: Interpreting Laboratory ValuesMonth One Monitoring biochemical data in parenteral nutrition

Objectives: Understand the importance of monitoring lab values with nutrition support Introduce potential complications that effect biochemical data Review assessment of biochemical data to target nutrition support

treatmentReferences:

1. Llop-Talaveron J, et al. Pharmaceutical interventions in metabolic and nutritional follow-up of surgical patients receiving parenteral nutrition. Farm Hosp. 2008;32(4):216-225.

2. Shenkin A. Biochemical monitoring of nutrition support. Ann Clin Biochem. 2006;43:269-272.

3. Lyman B. Metabolic complications associated with parenteral nutrition. J Infus Nurs. 2002;25:36-44.

4. Fubrman MP. Overview of micronutrients and parenteral nutrition. Support Line. 2002; 24: 3.

5. Kingley J. Fluid and electrolyte management in parenteral nutrition. Support Line. 2005; 27: 13.

Month Two DysnatremiaObjectives: Understand the role of fluid in alterations in serum sodium levels Understand causes and mechanisms of fluid shifts Understand the clinical manifestations of dysnatremia and corresponding

treatmentReferences:

1. Whitmire SJ. Nutrition-focused evaluation and management of dysnatremias. Nutr Clin Pract. 2008;23(2):108-121.

2. Funk GC, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36:304-311.

3. Huckleberry Y. Intravenous fluids: which solution and why?. Support Line. 2001; 23: 12

4. Boullata JI. Enteral nutrition practice: the water issue. Support Line. 2010; 32: 10

5. Rhoda KM, Porter MJ. Developing a plan of care for fluid and electrolyte management. Support Line. 2011; 33:10

Month Three Acid-Base BalanceObjectives: Understand the principles of acid-base balance Understand common causes of acid-base imbalance Understand treatment options for acidosis and alkalosis Understand the effects of parenteral nutrition on acid-base balance

References:1. Ayers P, et al. Diagnosis and treatment of simple acid-base disorders.

Nutr Clin Pract. 2008;23:122-127. 2. Segal R, et al.. Metabolic alkalosis in skilled nursing patients. Arch

Gerontol Geriatr. 2009;48:173-177. 3. Tsai IC, et al. Factors associated with metabolic acidosis in patients

receiving parenteral nutrition. Nephrology (Carlton). 2007;12:3-7.4. Simmons JF, Assell CC. Acid-base basics. Support Line. 2001; 23:6.

Month Four Interpretation of Albumin and Pre-albuminObjectives: Interpret albumin and pre-albumin values and understand the

circumstances in which change can occur Understand the impact of parenteral nutrition on albumin and pre-albumin

levels Understand the value of albumin as a predictor of clinical outcomesReferences:1. Donini LM, et al. Predicting the outcome of artificial nutrition by clinical

and functional indices. Nutrition. 2009;25:11-19.2. Franch-Arcas G. The meaning of hypoalbuminaemia in clinical practice. Clin

Nutr. 2001;20:265-269.3. Lim SH, et al. Prealbumin is not sensitive indicator of nutrition and

prognosis in critical ill patients. Yonsei Med J. 2005;46:21-26.4. Raguso CA, et al. The role of visceral proteins in the nutritional assessment

of intensive care unit patients. Curr Opin Clin Nutr Metab Care. 2003;6:211-216.

Month Five Refeeding SyndromeObjectives: Understand the populations at risk of refeeding syndrome and its clinical

manifestations Understand complications related to refeeding syndrome To be able to use biochemical data in the identification of refeeding

syndromeReferences:1. Boateng AA, et al. Refeeding syndrome: Treatment considerations based

on collective analysis of literature case reports. Nutrition. 2010;26(2):156-167.

2. Byrnes MS, et al. Refeeding in the ICU: An adult and pediatric problem. Curr Opin Clin Nutr Metab Care. 2011;14:186-192.

3. Khan LU, et al. Refeeding syndrome: A literature review. Gastroenterol Res Pract. 2011;2011:410971.

4. Marvin VA, et al. Factors contributing to the development of hypophosphataemia when refeeding using parenteral nutrition. Pharm World Sci. 2008;30:329-335.

Month Six Effects of OverfeedingObjectives: Understand the metabolic complications associated with overfeeding Understand how monitoring of lab values can help identify overfeeding

complications Interventions when overfeeding is suspected and/or in prevention of

overfeedingReferences:

1. Klein CJ, et al. Overfeeding macronutrients to critically ill adults: Metabolic complications. J Am Diet Assoc. 1998;98:795-806.

2. Kumar PR, et al. Hyperglycemia in hospitalized patients receiving parental nutrition is associated with increased morbidity and mortality: A review. Gastroenterol Res Pract. 2011;2011:760720.

3. McMahon MM. Management of parenteral nutrition in acutely ill patients with hyperglycemia. Nutr Clin Pract. 2004;19:120-128.

4. Charney P, Hertzler SR. Management of blood glucose and diabetes in the critically ill patient receiving enteral feeding. Nutrition in Clinical Practice. 2004; 19: 129-136

Appendix E: Example Curriculum: Managing Altered GI Anatomy

Example Curriculum: Managing Altered GI AnatomyMonth One Fistula

Objectives: Explain common reasons and locations for fistulas Understand how the location of a fistula (proximal vs. distal) affect nutrition

support Explain the rationale and appropriate use of parenteral nutrition for patient

with fistulas Understand the primary goal of nutrition therapy in patients with fistulasReferences:

1. Lloyd DA, Gabe SM, Windsor AC. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93(9):1045-1055.

2. Sepehripour S, Papagrigoriadis S. A systematic review of the benefit of total parenteral nutrition in the management of enterocutaneous fistulas. Minerva Chir. 2010;65(5):577-585.

3. Austin T. Nutrition management of enterocutaneous fistulas. Support Line. 2006; 28: 10.

Month Two Bowel ObstructionObjectives: Understand common reasons for bowel obstructions Explain how to provide nutrition support to patients with bowel

obstructions Explain what a pseudo-bowel obstruction is and how to ensure nutritional

adequacy in this conditionReferences:

1. Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg. 2000;180(1):33-36.

2. Fan B. Parenteral Nutrition Prolongs the Survival of Patients Associated With Malignant Gastrointestinal Obstruction. JPEN. 2007;31(6):501-10.

3. Scolapio J, Ukleja A, Bouras E, Romano M. Nutritional Management of Chronic Intestinal Pseudo-Obstruction. J. Clin. Gastroenterol. 1999;28(4):306-12.

4. Ukleja A. Altered GI motility in critically ill patients: current understanding of pathophysiology, clinical impact, and diagnostic approach. Nutrition in Clinical Practice. 2010; 25: 16-25

Month Three Bariatric SurgeryObjectives: Understand what role different areas of the GI tract play in digestion and

absorption and how resection of those areas warrants specific medical nutrition therapy

Understand the long-term nutritional effects of GI surgery Be able to explain specific nutrient deficiencies of concern and how to feed

a post-bariatric surgery patientReferences:

1. Ledoux S, Msika S, Moussa F, Larger E, Boudou P, Salomon L, Roy C, Clerici C. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obesity Surg. 2006;16(8):1041-1049.

2. Fobi MA. Surgical treatment of obesity: A review. J Natl Med Assoc. 2004;96(1):61-75.

3. Shikora S, Kim J, Tarnoff M. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29-40.

4. Koch TR, et al. Postoperative metabolic and nutritional complications of bariatric surgery. Gastroenterol Clin North Am. 2010;39:109-24.

5. Waters JM. Postoperative nutrition: past, present,and future. Support Line. 2010; 32

Month Four Short Bowel SyndromeObjectives: Be able to list and describe the signs and symptoms of short bowel

syndrome and why they occur Understand the important and how to provide early enteral nutrition for

SBS patients Understand use and rationale for oral rehydration solutions Be able to explain when to provide parenteral vs. enteral nutrition support. References:

1. Booth IW. Enteral nutrition as primary therapy in short bowel syndrome. Gut. 1994;35(1 Suppl):S69-72.

2. Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K. Short bowel syndrome: Clinical guidelines for nutrition management. Nutrition in Clinical Practice. 2005;20(5):493-502.

3. Vanderhoof JA, Young RJ. Enteral nutrition in short bowel syndrome. Semin Pediatr Surg. 2001;10(2):65-71.

4. Shutt B, Matarese LE. Fluid and electrolyte replacement with specialized oral rehydration solutions. Support Line. 2006; 28: 24.

5. Compher C, Metz DC, Rubesin S. Measurements of intestinal absorptive capacity in patients with intestinal failure. Support Line. 2006; 28: 3.

Month Five Blind loop syndromeObjectives: Understand the causes, Pathophysiology, and risk factors of blind loop

syndrome Understand medical and nutritional treatment of bacterial overgrowth

including probioticsReferences:

1. Bures J, Cyrany J, Kohoutova D, Miroslav F, Rejchrt S, Kvetina J, Vorisek V, Kopacova M. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010; 16(24): 2978-90.

2. Quigley EM, Rodrigo Q. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78-90.

3. Yang J, Pimentel M. Pathophysiology and medical/nutritional consequences of small intestinal bacterial overgrowth. Support Line. 2007; 29: 12

4. Worthington M, Ranz R. Use of probiotics in critically ill patients. Support Line. 2009; 31: 8

Month Six Ischemic Bowel/Mesenteric SyndromeObjectives: Understand the benefits and potential harm when feeding patients at risk

of ischemia Define and describe the Pathophysiology of superior mesenteric artery

syndrome Understand how to provide nutritional support to patients with ischemic

bowelReferences:

1. McClave S, Chang W. Feeding the Hypotensive Patient: Does Enteral Feeding Precipitate or Protect Against Ischemic Bowel? Nutr Clin Pract. 2003;18(4):279-84.

2. Ahmed AR, Taylor I. Superior mesenteric artery syndrome. Postgrad Med J. 1997;73:776-78.

3. McClave SA, Chang WK. When to feed the patient with gastrointestinal bleeding. Nutrition in Clinical Practice. 2005; 20: 544-550

4. Compher C. Intestinal failure in adults. Support Line. 2005; 27: 3. 5. Parekh NR, Seidner DL. Advanced in enteral feeding in the intestinal

failure patient. Support Line. 2006; 28: 18. 6. Decher N. Nutritional implications of opioid-induced bowel dysfunction

in chronic pain management. Support Line. 2009; 31: 19.