Tuesday, September 16, 2014

Dietitians role in preventing and treating hospitalized malnutrition

In the January 2014 issue of Today’s Dietitian, Mandy Corrigan, MPH, RD, LD, CNSC wrote an article focusing on 1. Creating an environment in which nutrition care is priority and 2. Proper recognition and diagnosis of hospital malnutrition.
Most hospitalized patients with declining nutritional status require nutrition intervention. Nutrition intervention is useful because it can improve or maintain nutritional status, delay short- and long-term complications, and reduce morbidity and mortality especially in undernourished patients. In the event a patient needs nutrition support, consistent administration and timing in nutrient delivery is important. Frequent interruptions due for example to bed positioning, procedures or issues with the GIT, can increase the risk of malnutrition. Patient nutrition care is one of the main responsibilities of the dietitian. Unfortunately not all facilities are able to provide adequate staffing to assess changes in health and nutritional status (Corrigan, 2014).
Health care systems across the United States are concerned about hospital malnutrition and the ability to provide patient care through medical nutrition therapy. In 2013, five organizations (Academy of Medical-Surgical Nurses, the Academy of Nutrition and Dietetics, ASPEN, the Society of Hospital Medicine, and Abbot Nutrition) developed the Alliance to Advance Patient Nutrition to show how nutrition relates to health outcome and to support effective nutrition care practices (Alliance to Advance Patient Nutrition, 2014; Corrigan, 2014). The Academy and ASPEN introduced two key criteria for diagnosis of adult malnutrition. These two criteria are etiology and severity. The Academy and ASPEN outline six characteristics to properly diagnosis nutrition. A minimum of two of the six characteristics must be present. The Alliance also included principles to support safe and effective delivery of nutrition care and services.
As a call for positive outcomes, president-elect of ASPEN and a nutrition support dietitian Ainsley Malone notes that nutrition interventions should be a collaborative effort among all members of the health care team (Corrigan, 2014). When meeting a patient for the first time, the nutritional screening and assessment can tell you a lot. You can use nutritional screening to identify the degree of malnutrition. Use an assessment and you can identify specific nutritional problems. For dietitians, addressing nutritional needs serves an important management function. Successfully preventing and treating malnutrition in hospitalized patients is crucial. The different approaches can be found within the article.
Corrigan, M. (2014). Hospital malnutrition - Standardized guidelines take center stage. Today's Dietitian, 16 (1), 40.


Alliance to Advance Patient Malnutrition. (2014). Retrieved from: http://malnutrition.com/


Monday, September 15, 2014

Vitamin E Shows its Value in the First 1,000 Days of Life 

We all know that vitamins and minerals play a vital role in our health. A new study has found that Vitamin E is especially important within the first 1,000 days of life starting at conception. Vitamin E is one of the the most difficult vitamins to obtain from the diet alone. Very few people are able to consume the dietary recommendations for Vitamin E everyday. Many people think that Vitamin E deficiency does not happen because the recommended intake is only 15 mg a day. However, deficiency in Vitamin E is happening at an alarming rate. Some symptoms of Vitamin E deficiency are evident but, other symptoms like neurological complications, brain development, and resistance to infection are not seen until late stages of the deficiency. 

Some of the best sources of Vitamin E are nuts, seeds, sunflower oil, and spinach. The average American diet does not include enough of these foods so 90 percent of men and 96 percent of women do not consume enough Vitamin E daily. The study found that those who are motivated to eat a healthy diet consume almost the recommended 15 mg/day. 

As stated earlier Vitamin E is critical for the nervous system and brain development. These two processes start at conception. This period is extremely crucial because the brain and nervous system only develop when in ureto. You cannot make up for it later in life by consuming a lot of Vitamin E. This study found out that it is recommended that pregnant women, nursing women and young children need a Vitamin E supplement because this is such a critical stage. One study found that a Vitamin E deficiency can cause neurological disorders and muscle deterioration. Another study found that people with higher concentrations of Vitamin E at birth had better cognition at age two. In conclusion, there seems to be a positive correlation between Vitamin E within the first 1,000 days and cognitive development. 

Maret Traber. Vitamin E Inadequacy in Humans: Causes and Consequences.Advances in Nutrition, September 2014


Moving into Management

     The Journal of the Academy of Nutrition and Dietetics reprint of the supplement “Management in the Dietetics Profession: Building a Framework for Success” had a great article titled “Moving into Management” that gives great practical advice for registered dietitians looking to advance their careers by going into management.

     The first piece of advice is to know your personality. RDs in management should be flexible and able to go with the flow of the situations and environment. RDs in management should be action-oriented, negotiable, personable, and organized. A manager should be able to enjoy all types of individuals, have confidence and be able to think quickly on their feet by giving a decision at a moment’s notice. Even if an RD doesn’t think s/he is suited to a management position, there is the possibility to grow into the role.

     A second piece of advice is to focus on your leadership skills. Management roles demand quality leadership skills and it’s important to strengthen and highlight these skills when moving into a management role. It is important to highlight leadership skills at employment or outside of work – the bottom line is being able to show the successful management of a group of people with a positive outcome.
     The third piece of advice in the article is to tailor your resume. It is important to tailor your resume correctly when seeking a management career. Focus on the competencies of the job requirements that you fulfill and indicate these skills high up on the resume. If dietetics is a second career, highlight any skills that are applicable (e.g. analytical thinking, managing finances, negotiating, building a team, or developing staff).
     The fourth piece of advice is to nail the interview. Dress for the job you want, not for the job you have. Know the company prior to your arrival to the interview and come with several examples of how you handled various situations. Be ready to discuss experience with customer service, interpersonal skills, and team building. Practice telling these experiences with family and friends and be prepared to focus on measurable outcomes.
     The fifth piece of advice is networking. Networking is critical and can provide the opportunity to develop leadership skills. Start by joining a group and becoming actively engaged in the group. Joining a professional organization provides the opportunity to network and the opportunity to find a mentor to build a management career.
Mathieu, J. (2012). Moving into management. Journal of the Academy of Nutrition and Dietetics, 112(5)Supplement, S16-S17. doi: 10.1016/j.jand.2012.03.017

Saturday, September 13, 2014

Becoming a Baby-Friendly Hospital
In recent years, the benefits of breastfeeding a newborn baby have become a frequent topic of discussion.  Breastfed babies have lower rates of diabetes, childhood leukemia, sudden infant death syndrome and other illnesses.  They are also less likely to suffer from malnutrition.  In light of this information, many hospitals have implemented “baby-friendly” policies.  These policies provide all the resources a new mom who wants to breastfeed needs.  Hospital staff members are educated on the basics of lactation and how to assist the new mother.  These policies also state that the newborn baby should be breastfeeding within the first hour of birth, the baby is to remain in the mother’s room 24 hours a day, no formula is given to a baby unless medically necessary, no pacifiers are given to the baby, and there is a staff member always available to assist the new mom with an issues related to breastfeeding.  However, in some baby-friendly hospitals mothers who choose not to breastfeed feel alienated or forced into breastfeeding.  This article discusses the issues of hospitals making the switch to baby-friendly policies.
To make for an easier transition, this article states that education is the most important tool when making the switch to baby-friendly policies.  They feel when the new mom is educated on the benefits of breastfeeding, they are more likely to do so and not feel pushed into it.  Some hospitals have focused more on community outreach programs which provide breastfeeding education long before a mother enters the hospital to give birth.  Hospitals who have implemented this policy have also found it helpful if nurses do not remove the baby from the room for routine examinations, so that breastfeeding babies are less likely to be given formula when away from their mothers.  Most mothers have been very appreciative of these new policies; however, there are a few who felt uncomfortable in a baby-friendly hospital with their decision to use formula.  While the hospitals’ goals is not to make anyone feel guilty, that still seems to be a problem with the implementation of these policies.  With that in mind, hospitals are trying to create a supportive atmosphere for all mothers no matter what their choice.  Overall, the programs have been successful at increasing the rates of breastfeeding.  One study done in 2010 found an increase in breastfeeding rates from 30% to 90% largely because of baby-friendly policies.

Schulte B. More U.S. Hospitals Adopting “Baby-Friendly” Policies.  Washington Post Web site.  http:// www.washingtonpost.com/local/more-us-hospitals-adopting-baby-friendly-policies/2014/09/10/ 49a86998-34c4-11e4-a723-fa3895a25d02_story.html. Published September 10, 2014.  Accessed September 13, 2014.

Neville K. Breastfeeding Bullies: A Case for Supporting, Not Shaming.  Food & Nutrition Web site. http: //www.foodandnutrition.org/September-October-2014/Besting-Breastfeeding-Bullies-Support-Not-Shame/. Published August 26, 2014.  Accessed September 13, 2014.


Friday, September 12, 2014

Improving opportunities for food service and dietetics practice in hospitals and resident aged care facilities

                As we all may know, nutrition is a vital aspect of patient care in not only a clinical setting, but also in long term care. One of the biggest concerns is primarily preventing malnutrition in patients to ensure better health outcomes. According to the article, “Although malnutrition is a significant issue, there appears to be a lack of awareness of malnutrition among hospital staff and management, perhaps because of such issues as lack of knowledge and training regarding nutritional status and assessment, communication issues, and their inability to recognize food and nutrition as key part of care” (Walton, 2012). With the elderly population being at a higher risk of malnutrition, it is extremely important that this topic is made aware by all patient support staff.

                One specific topic that the article addressed was food or plate waste. To an extent this cannot be completely avoided, it does impose quite a financial burden on many facilities with food waste averaging approximately 30%, and ranging from 6-65% (Walton, 2012). The article recommends making foods more appealing through the display of the dish, along with providing a comfortable atmosphere for the residents.

Along with this, dietitians mush serve as liaison between the health care team to communicate the needs of each patient to improve nutrient intake. There is not one quick fix for improving intake and every patient is different, so it requires a full team effort with innovative ideas to solve these dilemmas. It is also part of the dietitian’s job to assist in educating all medical staff on the benefits of proper nutrition. This will ensure that the patient will improve recovery as well as prevent any more issues from arising. Communicating this to nursing staff especially was noted specifically.

From the perspective of a management position, it is in the interest of the patient as well as the organization to support the nutritional needs of a patient and help to treat illness with nutrition and prevent deficiencies. As new research supports these theories, organizations have been placing more emphasis on dietitians and educating staff of a superior nutritional approach to health care. This article demonstrates the growing demands of dietitians in the food service management field.


Walton, K. (2012). Improving opportunities for food service and dietetics practice in hospitals and residential aged care facilities. Nutrition & Dietetics, 69(3), 222-225.


Sunday, September 7, 2014

Current Dietary Guidelines Could Increase Greenhouse Gas Emissions

If Americans altered their current diet to be in line with the USDA guidelines the greenhouse gas emissions that are connected with the agriculture production could increase dramatically. The study looked at about one hundred foods, and looked at what would happen if people changed their diets to follow the USDA 2010 guidelines. The results were alarming. If every American followed the guidelines and kept their caloric intake the same the greenhouse gas emissions would increase by twelve percent. If Americans reduced their caloric intake to 2,000 calories a day this would only decrease the gas emissions by one percent. This goes to show that the current dietary guidelines are not aligned with environmental agendas.

In the US in 2010, food production contributed about eight percent of the nation's greenhouse gas emissions. Cattle and dairy cows are the biggest contributor because cows do not use plant-based feed very efficiently. It takes a lot more feed for the cow to be able to produce milk or muscle so the cow is eating a lot more. By eating a lot more grass it takes more chemicals to keep the grass edible and more farming equipment which releases more fuel into the air. Both of these instances are increasing the greenhouse gas emissions. The only way to efficiently reduce the amount of agricultural greenhouse gas emission is to reduce the amount of meat and dairy people are consuming. People still need to eat meat and dairy and researchers are not suggesting that everyone become vegans, however reducing the amount of meat and dairy consumed would both help the environment and be healthier.

University of Michigan. "Dietary recommendations may be tied to increased greenhouse gas emissions." ScienceDaily. ScienceDaily, 5 September 2014. <www.sciencedaily.com/releases/2014/09/140905122715.htm>.

- KO

Gender gap in healthcare leadership

McDonagh, K.J., Bobrowski, P., Hoss, M.K., Paris, N., Schulte, M. (2014). The leadership gap: ensuring effective healthcare leadership requires inclusion of women at the top. Open Journal of Leadership, 3, 20-29. doi: 10.4236/ojl.2014.32003

This article points out some interesting points about women in leadership, and I thought it was relevant since our Internship program focuses on leadership, and the dietetics profession is primarily women.  The leadership focus as part of our Internship experience will help up in establishing informal leadership roles among our peers, which may lead to formal leadership roles in the organization.  Below is a brief abstract of the article. 

Not too long ago, health care was associated with disease and sickness, recently there has been a change in the thinking and the focus is now on wellness, prevention, primary care, and increased patient decision making.  This shift will require a different leadership model to provide higher quality care at lower prices.  Women leaders tend to be collaborative and transformational; styles that would support the changing health care community.  Studies have shown that diverse executive teams result in enhanced performance, however career development and succession planning for female leaders is not a priority for healthcare leadership.  There is a gap in the healthcare system, women are not in the top leadership roles, although they are qualified and well suited. 

Women make up the majority of students in medical schools and in graduate programs related to health careers.  Some of the reasons identified for the gender gap in healthcare are CEO’s work unreasonably long hours, potential leaders are unwilling to spend hours working at the expense of personal priorities, lack of financial resources for mentoring of future leaders, leadership development and succession planning is not a commitment of board of directors, and current leaders are not developing successors. 

Strategies such as CEO and board accountability, succession planning and leadership development were addressed in the article to increase gender diversity.  The idea of changing the corporate culture was also discussed by incorporating professional and personal goals into the workplace.  Ultimately, women have to take initiative to overcome the barriers to career advancement.