Bio

Clinical Focus


  • inflammatory bowel diseases
  • Pediatric Gastroenterology
  • complex chronic diseases

Academic Appointments


Administrative Appointments


  • Co-Director, Stanford Children's Inflammatory Bowel Disease Center, Department of Pediatrics (2014 - Present)
  • Physician Lead, ImproveCareNow Network for Pediatric Inflammatory Bowel Disease, Lucile Packard Children's Hospital (2013 - Present)

Honors & Awards


  • Clinical Research Award, Department of Pediatrics (Stanford) (2013)
  • Clinical Scientist Career Development Award (K08), NIH / NIDDK (2012-2017)
  • Stanford Society of Physician Scholars Research Grant, School of Medicine (2011)
  • Rosa and Marjorie Wann Fellowship Research Award, Lucile Packard Children's Hospital (2010)
  • Resident Research and Scholarly Performance Award, CCMC (2007)
  • Howard Hughes Research Scholar, Howard Hughes Foundation (2000)

Professional Education


  • Board Certification: Pediatric Gastroenterology, American Board of Pediatrics (2011)
  • Fellowship:Stanford University - Gastroenterology Department of Pediatrics (2011) CA
  • MS, Stanford University, Health Services Research (2011)
  • Board Certification: Pediatrics, American Board of Pediatrics (2008)
  • Residency:Steven and Alexandra Cohen Children's Hospital (2008) NY
  • Medical Education:University of Tennessee Memphis (2005) TN
  • BS, Duke University, Chemistry, Biochemistry (2000)

Research & Scholarship

Current Research and Scholarly Interests


My research interests are in the development of effective and cost-effective clinical approaches to treating gastrointestinal diseases, with an emphasis in Crohn's disease and ulcerative colitis. Using large databases, patient-reported outcomes, and decision science (e.g., Markov modeling), my overarching research goal is to optimize the use of various diagnostic and therapeutic strategies to improve patients' health, healthcare delivery, and pharmaco-economics of chronic gastrointestinal diseases - thereby informing patients, clinicians, and policy makers. Aside from inflammatory bowel disease, I am interested in applying available data and translating innovative ideas (e.g., technology, social media, and bioinformatics) to other complex chronic diseases, especially those with child health significance, through collaborative and inter-disciplinary efforts. Recently, we have adapted our investigations into the study of celiac disease, liver transplantation, functional abdominal pain, childhood obesity, acute and chronic diarrhea (e.g., Clostridium difficile infections), and microbiota. Whenever possible, our research attempts to compare the health and economic impact of clinical decisions from a health policy standpoint.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Effectiveness and Cost-effectiveness of Measuring Fecal Calprotectin in Diagnosis of Inflammatory Bowel Disease in Adults and Children. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Yang, Z., Clark, N., Park, K. T. 2014; 12 (2): 253-262.e2

    Abstract

    The level of fecal calprotectin (FC) can predict the onset of inflammatory bowel disease (IBD) with high accuracy and precision. We evaluated the cost-effectiveness of using measurements of FC to identify adults and children who require endoscopic confirmation of IBD.We constructed a decision analytic tree to compare the cost-effectiveness of measuring FC before endoscopy examination with that of direct endoscopic evaluation alone. A second decision analytic tree was constructed to evaluate the cost-effectiveness of FC cutoff levels of 100 μg/g vs 50 μg/g (typically used to screen for intestinal inflammation). The primary outcome measure was the incremental cost required to avoid 1 false-negative result by using FC level to diagnose new-onset IBD.In adults, FC screening saved $417/patient but delayed diagnosis for 2.2/32 patients with IBD among 100 screened patients. In children, FC screening saved $300/patient but delayed diagnosis for 4.8/61 patients with IBD among 100 screened patients. If endoscopic biopsy analysis remained the standard for diagnosis, direct endoscopic evaluation would cost an additional $18,955 in adults and $6250 in children to avoid 1 false-negative result from FC screening. Sensitivity analyses showed that cost-effectiveness of FC screening varied with the sensitivity of the test and the pre-test probability of IBD in adults and children. Pre-test probabilities for IBD of ≤75% in adults and ≤65% in children made FC screening cost-effective, but it was cost-ineffective if the probabilities were ≥85% and ≥78% in adults and children, respectively. Compared with the FC cutoff level of 100 μg/g, the cutoff level of 50 μg/g cost an additional $55 and $43 for adults and children, respectively, but it yielded 2.4 and 6.1 additional accurate diagnoses of IBD per 100 screened adults and children, respectively.Screening adults and children to measure fecal levels of calprotectin is effective and cost-effective in identifying those with IBD on a per-case basis when the pre-test probability is ≤75% for adults and ≤65% for children. The utility of the test is greater for adults than children. Increasing the FC cutoff level to ≥50 μg/g increases diagnostic accuracy without substantially increasing total cost.

    View details for DOI 10.1016/j.cgh.2013.06.028

    View details for PubMedID 23883663

  • Implementable Strategies and Exploratory Considerations to Reduce Costs Associated with Anti-TNF Therapy in Inflammatory Bowel Disease. Inflammatory bowel diseases Park, K. T., Crandall, W. V., Fridge, J., Leibowitz, I. H., Tsou, M., Dykes, D. M., Hoffenberg, E. J., Kappelman, M. D., Colletti, R. B. 2014

    Abstract

    : A health care system is needed where care is based on the best available evidence and is delivered reliably, efficiently, and less expensively (best care at lower cost). In gastroenterology, anti-tumor necrosis factor agents represent the most effective medical therapeutic option for patients with moderate-to-severe inflammatory bowel disease (IBD), but are very expensive and account for nearly a quarter of the cost of IBD care, representing a major area of present and future impact in direct health care costs. The ImproveCareNow Network, consisting of over 55 pediatric IBD centers, seeks ways to improve the value of care in IBD, curtailing unnecessary costs and promoting better health outcomes through systematic and incremental quality improvement initiatives. This report summarizes the key evidence to facilitate the cost-effective use of anti-tumor necrosis factor agents for patients with IBD. Our review outlines the scientific rationale for initiating cost-reducing measures in anti-tumor necrosis factor use and focuses on 3 implementable strategies and 4 exploratory considerations through practical clinical guidelines, as supported by existing evidence. Implementable strategies can be readily integrated into today's daily practice, whereas exploratory considerations can guide research to support future implementation.

    View details for DOI 10.1097/01.MIB.0000441349.40193.aa

    View details for PubMedID 24451222

  • Non-drug costs associated with outpatient infliximab administration in pediatric inflammatory bowel disease. Inflammatory bowel diseases Wu, M., Sin, A., Nishioka, F., Park, K. T. 2013; 19 (7): 1514-1517

    Abstract

    : Infliximab is the most widely used biological agent for Crohn's disease (CD) and ulcerative colitis (UC) but requires outpatient infusion units because of its intravenous administration requirement. The aim of this study was (1) to determine the average non-drug costs associated with each outpatient use of infliximab for pediatric inflammatory bowel disease and (2) to determine the proportion of non-drug costs associated with each outpatient infliximab use relative to the total cost of each encounter.: Hospital administrative and pharmacy databases were queried for all short stay unit encounters at Lucile Packard Children's Hospital at Stanford University linked to infliximab infusions for inflammatory bowel disease between January 1, 2006, and December 31, 2011. Infliximab drug and non-drug costs associated with CD and UC were compared.: A total of 771 unique encounters were generated for 76 pediatric patients (53 CD, 23 UC). For direct costs related to infliximab infusions for either CD or UC patients, more than 77% of the total health care costs per encounter were related to personnel (e.g., nursing), facility operations, and laboratory costs. Only 23% of the total costs were related to the actual infliximab drug costs. Based on an 80/20 payor mix of managed care versus government-subsidized insurance payers, 24.5% of the total reimbursements were applied to non-drug costs in CD and 20.9% in UC.: Non-drug costs represent a substantial proportion of the total cost of outpatient infliximab-related actual costs in inflammatory bowel disease. Personnel costs represent the largest segment of the non-drug costs. The actual drug costs of infliximab represent a small proportion of the total costs.

    View details for DOI 10.1097/MIB.0b013e318281f4f1

    View details for PubMedID 23567783

  • Cost-effectiveness of Universal Serologic Screening to Prevent Nontraumatic Hip and Vertebral Fractures in Patients With Celiac Disease. Clinical gastroenterology and hepatology Park, K. T., Tsai, R., Wang, L., Khavari, N., Bachrach, L., Bass, D. 2013; 11 (6): 645-653

    Abstract

    Patients with asymptomatic or poorly managed celiac disease can experience bone loss, placing them at risk for hip and vertebral fractures. We analyzed the cost-effectiveness of universal serologic screening (USS) vs symptomatic at-risk screening (SAS) strategies for celiac disease because of the risk of nontraumatic hip and vertebral fractures if untreated or undiagnosed.We developed a lifetime Markov model of the screening strategies, each with male or female cohorts of 1000 patients who were 12 years old when screening began. We screened serum samples for levels of immunoglobulin A, compared with tissue transglutaminase and total immunoglobulin A, and findings were confirmed by mucosal biopsy. Transition probabilities and quality of life estimates were obtained from the literature. We used generalizable cost estimates and Medicare reimbursement rates and ran deterministic and probabilistic sensitivity analyses.For men, the average lifetime costs were $8532 and $8472 for USS and SAS strategies, respectively, corresponding to average quality-adjusted life year gains of 25.511 and 25.515. Similarly for women, costs were $11,383 and $11,328 for USS and SAS strategies, respectively, corresponding to quality-adjusted life year gains of 25.74 and 25.75. Compared with the current standard of care (SAS), USS produced higher average lifetime costs and lower quality of life for each sex. Deterministic and probabilistic sensitivity analyses showed that the model was robust to realistic changes in all the variables, making USS cost-ineffective on the basis of these outcomes.USS and SAS are similar in lifetime costs and quality of life, although the current SAS strategy was overall more cost-effective in preventing bone loss and fractures among patients with undiagnosed or subclinical disease. On the basis of best available supportive evidence, it is more cost-effective to maintain the standard celiac screening practices, although future robust population-based evidence in other health outcomes could be leveraged to reevaluate current screening guidelines.

    View details for DOI 10.1016/j.cgh.2012.12.037

    View details for PubMedID 23357490

  • Geographical Rural Status and Health Outcomes in Pediatric Liver Transplantation: An Analysis of 6 Years of National United Network of Organ Sharing Data JOURNAL OF PEDIATRICS Park, K. T., Bensen, R., Lu, B., Nanda, P., Esquivel, C., Cox, K. 2013; 162 (2): 313-?

    Abstract

    To determine whether children in rural areas have worse health than children in urban areas after liver transplantation (LT).We used urban influence codes published by the US Department of Agriculture to categorize 3307 pediatric patients undergoing LT in the United Network of Organ Sharing database between 2004 and 2009 as urban or rural. Allograft rejection, patient death, and graft failure were used as primary outcome measures of post-LT health. Pediatric end-stage liver disease/model of end-stage liver disease scores >20 was used to measure worse pre-LT health.In a multivariate analysis, we found greater rates of allograft rejection within 6 months of LT (OR 1.27; 95% CI 1.05-1.53) and a lower occurrence of posttransplantation lymphoproliferative disorder (OR 0.64; 95% CI 0.41-0.99) in patients in rural areas. The difference in allograft rejection was eliminated at 1 year of LT (OR 1.18; 95% CI 0.98-1.42). Rural location did not impact other outcome measures.We conclude that rural location makes a negative impact on patient health within the first 6 months of LT by increasing the risk for allograft rejection, although patients in rural areas may have lower rates of developing posttransplantation lymphoproliferative disorder. Long-term adverse health effects were not seen.

    View details for DOI 10.1016/j.jpeds.2012.07.015

    View details for Web of Science ID 000313579900021

    View details for PubMedID 22914224

  • Characteristics and Direct Costs of Academic Pediatric Subspecialty Outpatient No-Show Events J Healthc Qual Perez, F., Xie, J., Sin, A., Tsai, R., Sanders, L., Cox, K., Haberland, C., Park, K. 2013; Mar 29
  • Cost-Effectiveness of Early Colectomy With Ileal Pouch-Anal Anastamosis Versus Standard Medical Therapy in Severe Ulcerative Colitis ANNALS OF SURGERY Park, K. T., Tsai, R., Perez, F., Cipriano, L. E., Bass, D., Garber, A. M. 2012; 256 (1): 117-124

    Abstract

    Inflammatory bowel diseases are costly chronic gastrointestinal diseases. We aimed to determine whether immediate colectomy with ileal pouch-anal anastamosis (IPAA) after diagnosis of severe ulcerative colitis (UC) was cost-effective compared to the standard medical therapy.We created a Markov model simulating 2 cohorts of 21-year-old patients with severe UC, following them until 100 years of age or death, comparing early colectomy with IPAA strategy to the standard medical therapy strategy. Deterministic and probabilistic analyses were performed.Standard medical care accrued a discounted lifetime cost of $236,370 per patient. In contrast, early colectomy with IPAA accrued a discounted lifetime cost of $147,763 per patient. Lifetime quality-adjusted life-years gained (QALY-gained) for standard medical therapy was 20.78, while QALY-gained for early colectomy with IPAA was 20.72. The resulting incremental cost-effectiveness ratio (?costs/?QALY) was approximately $1.5 million per QALY-gained. Results were robust to one-way sensitivity analyses for all variables in the model. Quality-of-life after colectomy with IPAA was the most sensitive variable impacting cost-effectiveness. A low utility value of less than 0.7 after colectomy with IPAA was necessary for the colectomy with IPAA strategy to be cost-ineffective.Under the appropriate clinical settings, early colectomy with IPAA after diagnosis of severe UC reduces health care expenditures and provides comparable quality of life compared to exhaustive standard medical therapy.

    View details for DOI 10.1097/SLA.0b013e3182445321

    View details for Web of Science ID 000306083300020

    View details for PubMedID 22270693

  • Perspectives on Cost-effective Medicine and the Use of Cost-effectiveness Analyses JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Park, K. T. 2012; 54 (1): 2-3

    View details for DOI 10.1097/MPG.0b013e3182354d50

    View details for Web of Science ID 000298550800002

    View details for PubMedID 22197853

  • Cost-effectiveness Analysis of Adjunct VSL#3 Therapy Versus Standard Medical Therapy in Pediatric Ulcerative Colitis JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Park, K. T., Perez, F., Tsai, R., Honkanen, A., Bass, D., Garber, A. 2011; 53 (5): 489-496

    Abstract

    Inflammatory bowel diseases (IBDs) are costly chronic gastrointestinal diseases, with pediatric IBD representing increased costs per patient compared to adult disease. Health care expenditures for ulcerative colitis (UC) are >$2 billion annually. It is not clear whether the addition of VSL#3 to standard medical therapy in UC induction and maintenance of remission is a cost-effective strategy.We performed a systematic review of the literature and created a Markov model simulating a cohort of 10-year-old patients with severe UC, studying them until 100 years of age or death. We compared 2 strategies: standard medical therapy versus medical therapy + VSL#3. For both strategies, we assumed that patients progressed through escalating therapies--mesalamine, azathioprine, and infliximab--before receiving a colectomy + ileal pouch anal anastamosis (IPAA) if the 3 medical therapy options were exhausted. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), defined as the difference of costs between strategies for each quality-adjusted life-year (QALY) gained. One-way sensitivity analyses were performed on variables to determine the key variables affecting cost-effectiveness.Standard medical care accrued a lifetime cost of $203,317 per patient, compared to $212,582 per patient for medical therapy + VSL#3. Lifetime QALYs gained was comparable for standard medical therapy and medical therapy + VSL#3 at 24.93 versus 25.05, respectively. Using the definition of ICER <50,000/QALY as a cost-effective intervention, medical therapy + VSL#3 produced an ICER of $79,910 per QALY gained, making this strategy cost-ineffective. Sensitivity analyses showed that 4 key parameters could affect the cost-effectiveness of the 2 strategies: cost of colectomy + IPAA, maintenance cost after surgery, probability of developing pouchitis after surgery, and the quality of life after a colectomy + IPAA. High surgical and postsurgical costs, a high probability of developing pouchitis, and a low quality of life after a colectomy + IPAA could make adjunct VSL#3 use a cost-effective strategy.Given present data, adjunct VSL#3 use for pediatric UC induction and maintenance of remission is not cost-effective, although several key parameters could make this strategy cost-effective. The quality of life after an IPAA is the single most important variable predicting whether this procedure benefits patients over escalating standard medical therapy.

    View details for DOI 10.1097/MPG.0b013e3182293a5e

    View details for Web of Science ID 000296383000007

    View details for PubMedID 21694634

  • Inflammatory Bowel Disease-Attributable Costs and Cost-effective Strategies in the United States: A Review INFLAMMATORY BOWEL DISEASES Park, K. T., Bass, D. 2011; 17 (7): 1603-1609

    Abstract

    The United States spends more for healthcare than any other country in the world. With the rising prevalence of both Crohn's disease and ulcerative colitis, inflammatory bowel disease (IBD) represents the leading chronic gastrointestinal disease with increasing healthcare expenditures in the US. IBD costs have shifted from inpatient to outpatient care since the introduction of biologic therapies as the standard of care. Gastroenterologists need to be aware of the national cost burden of IBD and clinical practices that optimize cost-efficiency. This investigation offers a systematic review of the economics of IBD and evidence-based strategies for cost-effective management.

    View details for DOI 10.1002/ibd.21488

    View details for Web of Science ID 000292415200017

    View details for PubMedID 21053357

  • Rationale for Using Social Media to Collect Patient-Reported Outcomes in Patients with Celiac Disease Journal of Gastrointestinal & Digestive System Park, K., et al 2014
  • Misdiagnosis of Alpha-1 Antitrypsin Phenotype in an Infant with CMV Infection and Liver Failure. Digestive diseases and sciences Arias, P., Kerner, J., Christofferson, M., Berquist, W., Park, K. T. 2014

    View details for DOI 10.1007/s10620-014-3094-6

    View details for PubMedID 24633574

  • The significance of serum total immunoglobulin E for in vitro diagnosis of allergic rhinitis INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY Chung, D., Park, K. T., Yarlagadda, B., Davis, E. M., Platt, M. 2014; 4 (1): 56-60

    Abstract

    Allergic rhinitis is diagnosed by clinical parameters with no widely accepted screening test. Measurement of total serum immunoglobulin E (IgE) has limited use in the general population due to a low negative predictive value. The value of total IgE level in select populations undergoing in vitro allergy testing remains unknown. The aim of this study is to determine the utility of total serum IgE in the in vitro diagnosis of allergic rhinitis.A retrospective chart review of patients undergoing testing for allergic rhinitis was performed. Clinical parameters, total IgE level, and enzyme-linked immunosorbent assay (ELISA) for serum-specific IgE levels were analyzed with multivariate logistic regression. The positive and negative predictive values and a receiver operating characteristic (ROC) curve were used to assess the utility of total IgE in predicting serum-specific IgE test results.Records from 1073 patients were reviewed. ROC curve for total IgE >150 IU/mL (Σ 0.88) indicates good discrimination in identifying patients with sensitization by in vitro testing, whereas low total IgE level had strong negative predictive value (0.87, IgE <10) in identifying negative specific IgE testing. Multivariate logistic regression showed that differences in covariables did not significantly change the odds of a positive in vitro allergy test panel.Serum total IgE level is useful in the in vitro diagnosis of allergic rhinitis. In vitro testing for specific IgE may be unnecessary in patients with low serum total IgE, whereas high total IgE level suggests that in vitro testing would confirm specific sensitizations in patients with allergic rhinitis.

    View details for DOI 10.1002/alr.21240

    View details for Web of Science ID 000329152400011

    View details for PubMedID 24227797

  • Impact of Immunosuppression on the Development of Epstein-Barr Virus (EBV) Viremia After Pediatric Liver Transplantation TRANSPLANTATION PROCEEDINGS Lu, B. R., Park, K. T., Hurwitz, M., Cox, K. L., Berquist, W. E. 2013; 45 (1): 301-304

    Abstract

    Pediatric liver transplant (OLT) patients are at risk of posttransplant lymphoproliferative disease (PTLD) from Epstein-Barr virus (EBV). This study examined the impact of induction and immunosuppression on EBV viremia.A retrospective chart review was performed on 197 pediatric patients and induction regimen, immunosuppression levels, and EBV viremia were documented for 1 year post-OLT. Logistic regression models determined associations between induction, immunosuppression, and EBV.Fifty six percent of patients developed EBV viremia. Incidence of EBV viremia was 73% with antithymocyte globulin (ATG), 63% with daclizumab, and 39% for neither, though the trend was not significant [ATG: odds ratio (OR) 0.19; 95% confidence interval (CI) 0.024-1.58; P = .125; daclizumab OR; 1.07; 95% CI 0.270-4.23; P = .925]. Tacrolimus immunosuppression levels were supratherapeutic 28.7% of the time; however, only supratherapeutic tacrolimus levels between 0 and 2 weeks increased EBV viremia at 2 to 4 weeks post-OLT (OR 1.80; 95% CI 1.10-2.94; P = .02). Three patients developed PTLD.The use of ATG and daclizumab induction likely does not play a role in the development of EBV viremia. Supratherapeutic tacrolimus levels 0 to 2 weeks post-OLT impact the development of EBV viremia at 2 to 4 weeks. The incidence of PTLD was low, suggesting better EBV and immunosuppression monitoring plays an important role in reducing PTLD.

    View details for DOI 10.1016/j.transproceed.2012.04.035

    View details for Web of Science ID 000315007200060

    View details for PubMedID 23267800

  • Clinical Applicability of the Incidence of Pediatric Peptic Ulcer Bleeding in the United States JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Park, K. T. 2012; 54 (6): 718-718

    View details for DOI 10.1097/MPG.0b013e318250a74d

    View details for Web of Science ID 000304115900003

    View details for PubMedID 22367340

  • Chylous Ascites After Laparoscopic Nissen Fundoplication DIGESTIVE DISEASES AND SCIENCES Park, K. T., Adikibi, B., MacKinlay, G. A., Gillett, P. M., Sylvester, K. G., Kerner, J. A. 2012; 57 (1): 28-31

    View details for DOI 10.1007/s10620-011-1808-6

    View details for Web of Science ID 000298968500005

    View details for PubMedID 21735080

  • Effects of rural status on health outcomes in pediatric liver transplantation: A single center analysis of 388 patients PEDIATRIC TRANSPLANTATION Park, K. T., Nanda, P., Bensen, R., Strichartz, D., Esquivel, C., Cox, K. 2011; 15 (3): 300-305

    Abstract

    Rural status of patients may impact health before and after pediatric LT. We used UI codes published by the USDA to stratify patients as urban or rural depending county residence. A total of 388 patients who had LT and who met criteria were included. Rejection, PTLD, and survival were used as primary outcome measures of post-LT health. UNOS Status 1 and PELD/MELD scores >20 were used as secondary outcome measures of poorer pre-LT health. Logistic regression models were run to determine associations. We did not find any statistically significant differences in pre- or post-LT outcomes with respect to rurality. Among rural patients, there was a general trend for decreased incidence of rejection (25.0% vs. 33.4%; OR 0.64, 95% CI 0.29-1.44), increased risk of PTLD (5.6% vs. 3.4%; OR 1.86, 95% CI 0.36-3.31), and decreased survival (OR 0.85, 95% CI 0.34-2.13) after LT. Rural patients also tended to be sicker at the time of LT than patients from urban areas, with increased proportion of Status 1 (OR 1.17, 95% CI 0.51-2.70) and PELD/MELD scores >20 (OR 1.20, 95% CI 0.59-2.45). From a single center experience, we conclude that rurality did not significantly affect health outcomes after LT, although a larger study may validate the general trends that rural patients may have decreased rejection, increased PTLD, and mortality, and be in poorer health at the time of LT.

    View details for DOI 10.1111/j.1399-3046.2010.01452.x

    View details for Web of Science ID 000289628100018

    View details for PubMedID 21450010

  • Aluminum in pediatric parenteral nutrition products: measured versus labeled content. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG Poole, R. L., Pieroni, K. P., Gaskari, S., Dixon, T. K., Park, K., Kerner, J. A. 2011; 16 (2): 92-97

    Abstract

    Aluminum is a contaminant in all parenteral nutrition solutions. Manufacturers currently label these products with the maximum aluminum content at the time of expiry, but there are no published data to establish the actual measured concentration of aluminum in parenteral nutrition solution products prior to being compounded in the clinical setting. This investigation assessed quantitative aluminum content of products commonly used in the formulation of parenteral nutrition solutions. The objective of this study is to determine the best products to be used when compounding parenteral nutrition solutions (i.e., those with the least amount of aluminum contamination).All products available in the United States from all manufacturers used in the production of parenteral nutrition solutions were identified and collected. Three lots were collected for each identified product. Samples were quantitatively analyzed by Mayo Laboratories. These measured concentrations were then compared to the manufacturers' labeled concentration.Large lot-to-lot and manufacturer-to-manufacturer differences were noted for all products. Measured aluminum concentrations were less than manufacturer-labeled values for all products.The actual aluminum concentrations of all the parenteral nutrition solutions were significantly less than the aluminum content based on manufacturers' labels. These findings indicate that 1) the manufacturers should label their products with actual aluminum content at the time of product release rather than at the time of expiry, 2) that there are manufacturers whose products provide significantly less aluminum contamination than others, and 3) pharmacists can select products with the lowest amounts of aluminum contamination and reduce the aluminum exposure in their patients.

    View details for DOI 10.5863/1551-6776-16.2.92

    View details for PubMedID 22477831

  • The use of Omegaven in treating parenteral nutrition-associated liver disease JOURNAL OF PERINATOLOGY Park, K. T., NESPOR, C., Kerner, J. 2011; 31: S57-S60

    Abstract

    Parenteral nutrition (PN), containing fat emulsions derived from soybean, has been implicated in the progression of PN-associated liver disease and cholestasis, particularly in infants with short bowel syndrome. Clinical use of Omegaven, a parenteral fish-oil emulsion, has been shown in recent studies to be a promising therapy to reverse liver disease and cholestasis. This review summarizes the rationale, relevant clinical investigations and future direction of Omegaven therapy for PN-dependent infants.

    View details for DOI 10.1038/jp.2010.182

    View details for Web of Science ID 000289236900009

    View details for PubMedID 21448206

  • Exfoliative Rejection in Intestinal Transplantation DIGESTIVE DISEASES AND SCIENCES Park, K. T., Berquist, W. L., Pai, R., Triadafilopoulos, G. 2010; 55 (12): 3336-3338

    View details for DOI 10.1007/s10620-010-1354-7

    View details for Web of Science ID 000284066200006

    View details for PubMedID 20683662

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