Glutamine is considered an essential amino acid during stress and critical illness. Parenteral glutamine supplementation in critically ill patients has been shown to improve survival rate and minimise infectious complications, costs and hospital length-of-stay. However, glutamine supplementation in patients receiving enteral nutrition and the best method of administration are still controversial. The purpose of this article is to provide a narrative review of the current evidence and trials of enteral and parenteral glutamine supplementation in multiple trauma patients. A search in PubMed and EMBASE was conducted and relevant papers that investigated the effect of enteral or parenteral glutamine supplementation in patients with multiple trauma were reviewed. Although recent nutritional guidelines recommend that glutamine supplementation should be considered in these patients, further well-designed trials are required to provide a confirmed conclusion. Due to the inconclusive results of enteral glutamine supplementation trials in patients receiving enteral nutrition, future trials should focus on intravenous glutamine supplementation in patients requiring enteral nutrition and on major clinical outcome measures (e.g. mortality rate, infectious complications).

BackgroundTrauma patients are characterised by alterations in the immune system, increased exposure to infectious complications, sepsis and potentially organ failure and death. Glutamine supplementation to parenteral nutrition has been proven to be associated with improved clinical outcomes. However, glutamine supplementation in patients receiving enteral nutrition and its best route are still controversial. Previous trials have been limited by a small sample size, use of surrogate outcomes or a limited period of supplementation. The aim of this trial is to investigate if intravenous glutamine supplementation to trauma patients receiving enteral nutrition is associated with improved clinical outcomes in terms of decreased organ dysfunction, infectious complications and other secondary outcomes.Methods/designEighty-eight critically ill patients with multiple trauma receiving enteral nutrition will be recruited in this prospective, triple-blind, block-randomised, placebo-controlled clinical trial to receive either 0.5 g/kg/day intravenous undiluted alanyl-glutamine or intravenous placebo by continuous infusion (24 h/day). Both groups will be receiving the same standard enteral nutrition protocol and the same standard intensive care unit care. Supplementation will continue until discharge from the intensive care unit, death or a maximum duration of 3 weeks. The primary outcome will be organ-dysfunction evaluation assessed by the pattern of change in sequential organ failure assessment score over a 10-day period. The secondary outcomes are: the changes in total sequential organ failure assessment score on the last day of treatment, infectious complications during the ICU stay, 60-day mortality, length of stay in the intensive care unit and body-composition analysis.DiscussionThis study is the first trial to investigate the effect of intravenous alanyl-glutamine supplementation in multiple trauma patients receiving enteral nutrition on reducing severity of organ failure and infectious complications and preservation of lean body mass.Trial registration numberThis trial is registered at http://www.clinicaltrials.gov. NCT01240291.

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Turnover phenomena attracted researchers from all over the world for generations. Most of this research was directed towards turnover antecedents with a few scattered conceptual and empirical studies related to turnover consequences. The purpose of this study is to investigate the impact of past turnover on future turnover in public organizations, in addition to test the mediation role of organizational climate in this relationship. Public schools as separate identities were the best choice as the study sample. Data were collected through questionnaires from 142 public schools in all educational regions in Oman. Two-step structural equation modeling approach, and nested model comparison were used for data analysis. The results revealed that: (1) past turnover predicts future turnover, significantly; (2) organizational climate fails to mediate this relationship. The study added to the body of knowledge by confirming Staw's hypothesis relating past turnover to future turnover in the Omani context. Human resource professionals and educational administration practitioners may play an important role in decreasing future turnover by tackling and decreasing past turnover, in addition to improving the relationship climate in schools. The study is limited to public schools in Oman and further studies about turnover consequences in the Arabic context are needed to affirm the results.