Tuesday, September 30, 2014

Future Medical Advances Associated with the "Microbiome"

       In the September 2014 edition of Today’s Dietitian, David Yeager highlighted a possible breakthrough project that could advance current medical treatment and disease prevention.  Multiple labs are participating in what is known as the Human Microbiome Project, which is under the National Institutes of Health.  The project entails two phases.  The first phase, which was completed from 2007-2013, was aimed to identify and describe the microbial community that lives within the human body.  The second phase, which is started in 2013 and will continue until 2015, aims to describe the biology between the interaction of the microbes and the human body.  The ongoing study is hoping to target how health is maintained through the microbiome and how to treat disease (specifically digestive disease). 
       Various studies have proved that microbiota plays a key role in health outcomes.  For instance, the article mentioned a study involving transfer of microbes from a lean individual to an obese individual.  Although the results were short lived, there was a decrease in insulin resistance and glucose intolerance. Krista King, a senior pediatric dietitian at Texas Children’s Hospital and spokesperson for the Academy of Nutrition and Dietetics states, “The microbiome makes up 1% to 2% of the adult body, so it could essentially be considered a separate organ.  Previously, we thought it was just there to help us with digestion of foods and the production of certain vitamins, such as vitamin K or vitamin D, but now we’re seeing that it’s playing a much bigger role than that.”  Each person’s microbiota is described as a fingerprint, each being unique to each individual.  Now more then ever there is talk of personalized health plans as well as diets that are tailored according to each individual’s biology.  Microbiota may be the future break through to be able to accurately prescribe individualized diets. 

Yeager, D. (2014, September). Mapping the gut microbiome. Today’s Dietitian, 16, 12-13. 


Monday, September 29, 2014

Nutritional Quality of Emergency Foods

The purpose of this article was to categorize and analyze the nutritional quality of emergency foods distributed by the Oregon Food Bank. The supplies that are distributed from food banks to soup kitchens, food pantries, and other charitable structures are most often obtained from wholesalers, manufacturers, and government sources. Food Banks distribute foods to food insecure individuals throughout the nation in attempt to reduce malnutrition by offering supposedly nutrient adequate foods. According to the article, “food-insecure populations experience higher rates of chronic conditions, such as heart disease, diabetes, high blood pressure, and obesity” (Hoisington et al, 2011).

Food groups for the analysis were primarily determined by MyPyramid and the 2005 DGA. Over a year’s period (2004-2005), over 36 million pounds of food distributed by the Oregon Food Bank was analyzed. The results of the study indicated that meat/beans, grains, and vegetables were distributed more than fruit and dairy products. In addition to this, 1/3 of the products distributed fell into other categories that are not traditionally part of the MyPyramid. Examples included condiments, non-calorie providing beverages (coffee, tea, etc.), convenience meals, baking supplies, and discretionary foods (snacks like chips and donuts). Though the composition of the foods distributed were not exactly ideal, it is better to provide something rather than nothing to help those in food insecurity.

Some individuals in management could be involved in a non-profit or charity organization, and they may not always have the option of being picky with the foods that are donated. As a dietitian it is incredibly important to understand the importance of nutritional foods, especially in the context of preventing malnutrition in food insecure individuals. Since the population is at higher risk of chronic disease they are more likely to come into contact with healthcare professionals – primarily dietitians. Due to these points, dietitians in a variety of fields should be knowledgeable when dealing with this population.

Hoisington, A., Manore, M. M., & Raab, C. Nutritional quality of emergency foods. Journal of the American Dietetic Association, 111(4), 573-576.


Sunday, September 28, 2014

“Virtual Nutrition Counseling”

            Although classic nutrition counseling has occurred in settings like a hospital or within a private practice, advances in technology have opened up a new arena for nutrition counseling.  New modes of correspondence with patients include phone meetings, video chatting, public settings and even house calls.  This way of communication benefits patients with busy schedules or who may live in remote locations.  It can also benefit RDs for the same reasons.

            Virtual healthcare practices are also called telehealth and are not new within the medical field, but are gaining popularity within the dietetic profession.  Telehealth and Telenutrition have been defined by the Academy Definitions of Terms List as:

“Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Telehealth will include both the use of interactive, specialized equipment, for such purposes as health promotion, disease prevention, diagnosis, consultation, therapy, and/or nutrition intervention/plan of care, and non-interactive (or passive) communications, over the Internet, video-conferencing, e-mail or fax lines, and other methods of distance communications for communication of broad-based nutrition information.

Telenutrition involves the interactive use, by a RD or RDN, of electronic information and telecommunications technologies to implement the Nutrition Care Process (nutrition assessment, nutrition diagnosis, nutrition intervention/plan of care, and nutrition monitoring and evaluation) with patients or clients at a remote location, within the provisions of their state licensure as applicable.”

Dietitians need to do their research before deciding on this career move.

            Telenutrtion can result in the ability to manage more clients for a dietitian and for those patients to receive a better experience.  Dietitians are able to answer quick calls from a client who just has a few questions and does not want to be scheduled for an appointment where they would be charged for much un-needed time.  Making house calls means that dietitians can actually see what the client is eating and teach them how to correctly read food labels.

            There are issues in this developing profession.  Most insurance will not cover virtual counseling, but dietitians quoted in this article have said their clients have no problem paying for their services.  HIPPA is another concern dietitians need to be aware of if consulting in public places.

            Overall, I think this new area of dietetics sounds great!  It allows flexibility for both the patient and dietitian.  Managing our own business means we get to set the tone for the way our profession should be perceived, including the cost and value of our services.


Saturday, September 27, 2014

Electronic Medical Records

          Transitioning to electronic medical records (EMRs) from paper charts can help facilitate patient visits and help run practice more efficiently. Registered dietitians (RDs) have noted that paper charts look unprofessional when sending them to physicians and typing up patient records and notes is time and labor intensive. Paper charts can take up valuable space and can accidently be destroyed or misplaced. It is also easy for paper charts to be stolen if not locked away properly. The benefits of EMRs have interested RDs in private practice in this methodology of charting.

            EMRs make housekeeping tasks easier. They can store patient’s vital stats, contact information, insurance, referring doctors, medications, and lab results in one location. EMRs also make it easy to keep notes on patients and what was discussed in sessions. Some EMRs also have billing features, which can save the company time and money if the company doesn’t have an accountant or office manager for billing. EMRs have also saved RDs time spent charting, which leads to more personal time and a more relaxed sense to the RD.
            EMRs can also make the time with clients with productive. Some EMRs feature nutrition analysis tools, BMI history chart, weight history chart and other tools to view the client’s progress. EMRs allow the RD to chart on the client during the visit, some as easy as choosing items from a drop-down box. Some programs feature the ability to generate a report with a summary of the visit, menus, and instructions to provide to the client.
            Some problems with EMRs are storing information in a cloud system involves internet outages, power outages, or lengthy technical glitches. Another possible problem is losing the ability to calculate math problems since everything is automated, which could result in losing certain skills if you don’t practice them.
Orenstein, B. W. (2014). Electronic medical records. Today’s Dietitian, 16(9):42. Retrieved from: http://www.todaysdietitian.com/newarchives/090114p42.shtml.

Thursday, September 25, 2014

Crain’s brings together Northeast Ohio hospital leaders

The leaders from MetroHealth, Cleveland Clinic, Sisters of Charity, Akron General and University Hospitals met on September 18 at the Cleveland Convention Center to discuss the current and future state of healthcare.  Healthcare as we know it is changing.  The model of health care is changing from treating sick people to preventative care.  The leaders discussed slashing budgets by the millions.  The number of hospitals beds has decreased from 1 million to 800,00 across the country, and average occupancy at 65%. Hospitals are are forced to do things differently since there are fewer patients and hospitals are generating less revenue.  Physicians are collaborating together to share knowledge,
The costs for patient services vary across hospitals, due to the difficulty of assigning a value to services such as research and staff education and then throw in the antiquated way costs are reported to Medicare, which distorts the true cost of care.



Sunday, September 21, 2014

CMS Final Rule on Therapeutic Diet Orders

           The new rule from the Centers of Medicare and Medicaid Services (CMS) took effect on July 11, 2014. The new rule issued by CMS will allow qualified RDNs and qualified food and nutrition practitioners working in hospitals the ability to order therapeutic diet orders independent from a physician’s supervision. It also provides RDNs the privilege to order nutrition related laboratory tests for monitoring therapeutic diet orders with or without supervision of a physician.

            Ordering privileges for nutrition related laboratory tests are determined by hospitals in accordance with state laws and other requirements of CMS. The rule increases flexibility for health care practitioners to improve care, save on costs, and provide a more patient centered care experience.
            This rule was enabled with the help of the Academy of Nutrition and Dietetics (A.N.D.), whom showed CMS substantial evidence that the current practice of the physician ordering the therapeutic diet resulted in wasted time and resources and delayed appropriated nutrition services. A.N.D. also highlighted the increased occurrence of hazardous complications that have resulted from the inappropriate diet orders written by other health practitioners.
            Work still remains since the rule defers to hospitals to determine regulatory flexibility in regards to the ordering of nutrition diet orders. CMS also does not have a definition for the term therapeutic diet in terms of the hospital setting. A.N.D. does have a definition for this term and are working on definitions for nutrition supplements and dietary supplements in the hopes to have these definitions adopted by CMS.
            This is just one small battle won for RDNs in the fight to have the ability to order therapeutic diet orders and nutrition related laboratory tests without physician supervision in a hospital. The rule still needs to be modified so that it protects RDNs more, since it is still deferred to the hospital to determine this decision.
Boyce, B. (2014). CMS final rule on therapeutic diet orders means new opportunities for RDNs. Journal of the Academy of Nutrition and Dietetics, 114(9), 1326-1328. doi: http://dx.doi.org/10.1016/j.jand.2014.07.002

Friday, September 19, 2014

A Day in the Life of a Nutrition Service Director

                The goal of this article was to illustrate the common daily duties associated with being a Nutrition Service Director in school food service. The tasks performed in the article were actually taken from the day planner notebook of a Nutrition Service Director attempting to manage issues that arise in the line of work.

                For this Director, the day starts very early in the morning before any other staff arrive to prepare coffee to ensure staff satisfaction. Being the first individual in has its perks-- in this case, discovering a broken water main and contacting the correct personal to repair damages and find substitutes for last minute call offs. The day continues into answering voicemails about the daily menus to concerned parents and elaborating on the nutritional value of the foods included. With little to no rest following comes correcting a food ingredient being used in recipes, meeting with sales teams offering new products, mingling with students to get input on the final product, and attending meetings to ensure proper safety measures. The days may be long, challenging, and diverse; but the article concludes with the thought of it being a very rewarding career for those Dietitians who are interested in a management position.

                I found this article very intriguing and I think that it demonstrates how sometimes the worst incidents can happen at the most incredibly inopportune times. As future Dietitians, it is extremely important for us to keep our composure while dealing with problems (not only in food service, but all areas of practice) to ensure high quality job performance and outcomes.


Spinks, B. (2010). A day in the life of a nutrition services director. Food Management, 45(5), 10-10.