Fellowship opportunities for physicians have also diminished, and there is some concern about what the future holds for physicians principally interested in parenteral and enteral nutrition. Last year by vote of its members it chose to disband and become a component of the American Society of Nutrition. Hopefully this group of individuals will maintain their interest in this field and continue to promote the improvement of parenteral and enteral nutrition for the hospitalized patient. However the likelihood of getting specialty recognition from the American Board of Medical Specialties is dim under the present conditions.
How does this bode for the future? Presumably there will always be some physicians trained in clinical nutrition, but some programs, like the exemplary program at MIT which trained many of the academic clinical nutritionists, have been discontinued and not been replaced. Certainly there is ample evidence for the need for such individuals.
For instance one of the most important recent developments in clinical medicine has been the demonstration that tight blood glucose control in the critically ill can dramatically improve the morbidity and mortality of patients . However this was primarily a study in cardiac surgical patients, and a similar study in medical patients by the same group demonstrated that tight blood glucose control improved morbidity but did not affect mortality . In fact in those medical patients who received therapy for less than 3 days, mortality was actually increased. These superb innovative studies were primarily conducted by an endocrinologist who is a specialist in critical care.
The medical patients in the second study received the initial hypertonic dextrose followed by inadequate nasogastric tube feeding for the first 3 days providing substantially less calories and grossly inadequate protein .
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It may well be that it is the combination with tight glucose control in the setting of adequate feeding that is essential to achieve all the benefits rather than the control of hyperglycemia alone. Similarly a recent study in cardiac surgical patients receiving tight glucose control during their surgery and tight regulation of both treatment and control postoperatively showed no benefit and, in fact, a suggestion of harm in the treatment group .
Perhaps lowering blood glucose in cardiac patients not receiving hypertonic dextrose before revascularization may deprive the heart of an essential fuel. Having some physicians thoroughly trained in clinical nutrition to discern these possibilities may be important in the future to design and interpret the results of clinical trials.
Simons, 57, of Lubbock, Texas has not eaten for two years. Instead, he is nourished by chemicals that are pumped into his bloodstream by an apparatus he wears all his waking hours. The device, invented by Dr. Stanley Dudrick of Houston, is cumbersome, and its menu hardly compares with a steak dinner. But without it, Simons, who has had cancer of the bowel, would almost surely be dead.
Nearly patients at the University of Texas Medical Center are undergoing similar nutritional therapy. Each owes his survival to Dr. Dudrick was turned from a fledgling cardiac surgeon into a pioneer nutritionist one day when he was an intern in Philadelphia. I was too dumb to make that observation myself. From 10 to 40 percent of hospital deaths are still caused, he believes, by malnutrition. Patients with gastrointestinal cancer are especially vulnerable, as well as those with kidney or liver failure or burn trauma.
Sir Christopher Wren experimented with intravenous feeding of dogs as early as the 17th century. In its modern traditional form most familiar in the glucose drip bottle , it cannot support life for long, however. Dudrick solved the problem by developing a complete nutritive compound.
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In some cases druggists or patients themselves can prepare the mixture. Parenteral refers to bypassing the intestines. In he astounded a medical convention in Germany with the news that he had raised six beagle puppies entirely on TPN for days.
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In he first tried it on six humans with apparently terminal illness; all recovered and four are still alive. Eldest of four children of a Nanticoke, Pa. Both his sisters are nurses. Success will depend on campaigning for the technique, while simplifying it. I want to leave something better behind when I go, rather than just practice medicine the way it has always been done. Dudrick, M. The basic investigative development and subsequent successful clinical application of this highly effective therapeutic modality has been described as one of the four most significant accomplishments in the history of the development of modern surgery, together with the discovery and development of asepsis and antisepsis, antibiotic therapy and anesthesia JAMA , It has also been acknowledged as one of the three most important advancements in surgery during the past century along with open heart surgery and organ transplantation.
Born in Nanticoke, Pennsylvania, April 9, , Dr. Dudrick received his B. He was a member of Phi Beta Kappa honor fraternity and was awarded the Williamson Medal as the outstanding member of his graduating class. His M. Jonathan E. Rhoads until After his training, he joined the faculty at Penn and ascended in rank from Instructor to Professor of Surgery at his alma mater within five years.
A prolific medical writer, Dr. Dudrick was acknowledged by Current Contents, a publication of the Institute for Scientific Information, as the author or co-author of 2, scientific reference citations during a 13 year period, the most for any general surgeon in the literature.
His more than published works include a wide variety of topics on the care and management of surgical patients, especially those with complex nutritional, metabolic, critical care and re-operative problems.
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Since , he has served on more than fifteen Editorial Boards of scientific journals and professional publications including the prestigious Annals of Surgery. Among the more than honors and awards which Dr. Khursheed N. Jeejeebhoy fled seven years later with his family to India to escape the Japanese invaders.
He attended medical school in Vellore, India; trained in London, England; married and had three children; and in , accepted a position at the Toronto General Hospital and the University of Toronto. From the beginning of his career, he was always on the forefront of research: he was one of the first to discover lactose intolerance. In , with a surgical colleague, he was experimenting with TPN on post-surgical patients when Judy Ellis Taylor came into his care.
He obtained his PhD from London University in He became division director of gastroenterology at the University of Toronto and the Toronto General Hospital. Currently, he is directs nutrition support and is a staff physician at St. He is also a professor of medicine, professor in the department of nutritional sciences and professor in the department of physiology, all at the University of Toronto.
He has published over peer-reviewed articles, abstracts and book chapters. He has a CIHR funded research program. He is on the editorial boards of nutritional journals and contributes to the Medical Post. He has been elected senior member of the Canadian Medical Association. This determined young woman intended to live and expected him to save her.
He took her up on her challenge and developed first a viable, long-term form of TPN, then a version Judy could use at home. With Judy such a success, Dr. Jeejeebhoy Jeej to his patients and colleagues bent his efforts to saving other lives with TPN and to learning more about the nutrients that the human body needs and in what dosages, both orally and intravenously, so that he could better nourish his patients and reduce their suffering.
He has written over papers and books and chapters ; was made professor of medicine, physiology, and nutrition at the University of Toronto; has lectured in virtually every country; and has taught many graduate students from Europe, North America, Asia, and Australia, as well as the first doctor allowed to leave China to study temporarily after China started opening up to the west.
His patients are intensely loyal to him, for his understanding, listening skills, expertise. In , he moved to St. He entered the commercial arena when he conducted research in and developed a radical new, nutritional way to improve the function of patients with congestive heart failure. These nutrients are Coenzyme Q10, and the amino acids Taurine and Carnitine. At the end of , he retired, sort of, a few years after becoming Professor Emeritus at the University of Toronto due to mandatory retirement at age He closed his university lab at the end of when his last grant ran out.
That ended a year run of successful research grant applications and groundbreaking research.