Early Enteral Feeding at Forrest General Hospital

Dr. Mark DeLegge recently traveled to Hattiesburg, Miss., where he presented on the topic of early enteral feeding to a group of pharmacists, physicians, nurses and dietitians at Forrest General Hospital. This was an invited lecture at the request of the hospital’s dietitians and nutrition support team.

 

The highlight of the presentation focused on the use of gut, specifically stimulating the imbedded immune system by the use of enteral nutrition.  Discussed in the presentation were early enteral feeding’s impact on clinical outcomes, impediments to delivering enteral feeding in the intensive care unit and the science of enteral access. Dr. DeLegge stressed that “there needs to be a major shift in the perception of nutrition, specifically enteral nutrition, and its importance to maximizing clinical outcomes. Dietitians and nutrition specialists need to take the lead role in driving their patient care teams down the road of early enteral access and early enteral nutrition. Frankly, there are drugs that don’t achieve the same level of improvement in clinical outcomes in the critically ill patients that can be achieved with early enteral nutrition.”

There was quite a bit of discussion about the need for a feeding protocol in the ICU to encourage the use of early enteral nutrition and the need for clinicians to stop using gastric residual volumes below 500 cc as a reason to withhold or terminate the delivery of enteral nutrition.  All in attendance agreed that the ASPEN/SCCM guidelines certainly set the groundwork for earlier, more aggressive use of enteral nutrition.

The Road Map to the Finish Line

The pending sale of Satiety's Intellectual Property is another example of the problem in the United States with regards to new technology introduction into the United States. Satiety was one of a number of transoral GI devices that is meant to treat obesity; a problem that was in pandemic form the last time I checked. Venture capital was the economic push to get it to market. As usual, the finish line... FDA approval and insurance reimbursement remained elusive, as the goals of what needed to be obtained in clinical and safety results were either never clearly defined or set at a level that no therapy, other those achieved short-term with a major operation for weight loss, could achieve. I have to believe there is some concession given to the fact that we cannot treat all obesity with surgery given the costs and risks of the procedures.

This is a prime example of the disconnect currently between the inventor, capital, the FDA and reimbursement. There are 4 pots of money for an inventor or start-up:

1. Grants (good luck)  
2. Angel investment (limited in amount)
3. Venture capital
4. Friends, families and fools (Bill Gates is not my dad or cousin)

If you look at that, it is quite clear that there has to be a roadmap to get to the finish line (FDA clearance/reimbursement) that is known and achievable, if we hope to bring anything new to the GI physician and GI patients that is not a "me to" product. People funding projects want to know they have a reasonable chance for success or, they could as effectively burn $20 dollar bills in the backyard on their grill. That's where the DeLegge Medical Technology Accelerator can be so helpful; as a broker and director. Taking technology and having a clear pathway to success has to be established before the first prototype is conceived. I have to think that everyone involved (FDA, payors, inventors) actually wants patients to get better with the help of new technology at some point. If not, then we are in real trouble. It might take a coordinated patient "uprising" to change the playing field with the FDA and payors if those goals cannot be predetermined and achievable through "reasonable" means.

Physician Nutrition Summit

Our own Mark DeLegge, MD recently attended the Physician Nutrition Summit that addressed physician shortages in the practice of nutrition in the United States.  This was a follow-up conference from the inaugural meeting on this topic in 2009, which had 41 participants.  Both of these meetings were sponsored by Abbott Nutrition and organized by the American Society of Parenteral and Enteral Nutrition.  The proceedings from that conference were published in the recent November 2010 supplement of the Journal of Parenteral and Enteral Nutrition.  Dr. DeLegge was a lead or participating author in three of the summit’s articles in this supplement.

This recent meeting took place in December of 2010 in Chicago and brought back many of the original participants of last year’s summit in Orlando.  Numerous societal organizations were represented such as the American Association of Clinical Endocrinologists, the American Society of Bariatric Medicine, the American Gastroenterological Association, the American Dietetic Association and the American Medical Association.  Dr. DeLegge was one of four program chairs and led discussions focused on how to measure success of an intervention to solve the problem of physician shortage and what are the next steps to take to achieve this goal.  The group as a whole flushed out issues of the group’s overall mission, the governance structure and the appropriate partners the group needed to establish to achieve its goals of approving physician attraction to the field of nutrition.  In addition, the group was going to focus on measuring the problems of over-nutrition in the community and under-nutrition in the hospital as a mechanism of establishing the reason why more physicians are needed in nutrition support.  Plans were made for an annual meeting and intermittent conference calls to ensure all members remained organized to the success of the project.

For more information on the Physician Nutrition Summit:

Notes from the 2009 Summit in Orlando

Release of position papers for this year’s Summit in Chicago

What Are You Doing With YOUR Idea???

We here at DeLegge Medical have been using the 37signals suite of customer relationship management tools for the past few months. If you have not had a chance to check out their web-based CRM programs (www.37signals.com), we highly suggest you give them a look!

The founder of 37signals, Jason Fried, has written a great little book called Rework. One of the major messages in the book is the "start making something" factor. How many of you out there have an idea? A grand master plan that is bouncing around in you brain? Have you put anything into action yet? What's holding you back?

Fried states, "Think your idea's that valuable? Then go try to sell it and see what you get for it. Not much is probably the answer. Until you start making something, your brilliant idea is just that, an idea. And everyone's got one of those." The DeLegge Medical Technology Accelerator is designed to help you get to that next step: Making Something. We can assist with IP Protection, Prototype Development and Testing, Market Analysis and any other needs you have to get your idea out of your head and on the table.

Remember, "Ideas are cheap and plentiful. The original pitch idea is such a small part of a business that it's almost negligible. The REAL question is how well you execute. Contact us today at 877-971-6202 or Steven@DeLeggeMedical.com to get your idea off the ground and running today!

On the Road in Brussels

Dr. Mark H. DeLegge just returned from Brussels, Belgium where he attended and helped lead a multi-country conference on nutrition treatments of hospitalized patients. This event was coordinated through Baxter Healthcare and physicians from Poland, Slovakia, Czechoslovakia, England, France, Belgium, Sweden, Norway, Canada, Portugal, Spain, Bulgaria, Russia and the United States were represented.

A large emphasis of the conference was to examine different practices with regards to nutrition intervention in critically-ill, hospitalized patients. Different practices included early enteral nutrition, supplemental parenteral nutrition, high nitrogen prescribing and the validity of energy:nitrogen ratio in the treatment of hospitalized patients. There were reviews presented regarding these important concepts and a discussion of the variation in practices between countries, often based on historical practice.

Case presentations of actual complicated patients were presented, with input from the group and the leaders surrounding appropriate care and getting to a “best practice.” Dr. DeLegge presented information regarding current practices, new data which is helping to define our future practice and an examination of the gaps in research that need to be filled to allow us to improve our practice. A decision was made to continue this conference in future years.

A Great Time in the Upstate

What a great few days in the Upstate!

DeLegge Medical spent Wednesday and Thursday at the 6th Annual SC MedTech Entrepreneurship & Industry Conference at the Hyatt Regency in Greenville, S.C. We had an opportunity to meet with a number of great like-minded medical technology folks from around the state and presented our new Lowcountry Medical Technology Accelerator project to the attendees at the conference. It was a wonderful chance to catch up with fellow colleagues that we have not worked with recently and build some new connections with companies that are just starting up in the Palmetto State.

Special thanks to Matt Gevaert, Jennifer Noel and the rest of the planning committee for organizing such a successful event! We look forward to seeing everyone throughout the year and at next year's event as well.

SC MedTech Entrepreneurship & Industry Conference

DeLegge Medical will be at the 6th Annual SC MedTech Entrepreneurship & Industry Conference on Thursday, November 18 at the Hyatt Regency in Greenville, S.C.  Dr. Mark DeLegge will make a presentation at the conference on our new Lowcountry Medical Technology Accelerator.

The 2010 SC MedTech Entrepreneurship & Industry Conference is South Carolina's annual event focusing on the creation and growth of medical device and technology business opportunities. Now in its 6th year, this meeting has become the annual one-stop shop to meet and connect with biomedical, clinical and regulatory professionals including technical entrepreneurs, venture capitalists and academics.

2010 marks the first year the conference will be supported and managed by the South Carolina MedTech Industry Council. This newly formed, industry-led Council's mission is to foster a competitive business environment in South Carolina for medical device companies beginning at conceptualization. This conference will help to support the growth and success of the medtech industry in South Carolina by increasing the industry's effectiveness and by encouraging cooperation and the exchange of information.

If you are interested in the Lowcountry Medical Technology Accelerator and cannot make it to the SC MedTech Entrepreneurship & Industry Conference, please contact us at 877-971-6202 for more information.