Saturday, April 19, 2014

How Advanced-Practice Dietitians Do Their Jobs

In the most recent volume of the Journal of the Academy of Nutrition and Dietetics, there was a really informative Delphi study on advanced registered dietitians and the clinical activities they perform. 

Unlike a lot of other professions in the medical field, it's still hard to define what it means to practice advanced-level dietetics. This Delphi study surveyed 117 dietitians who have had an average of 25 years clinical experience. Below are some of the areas the study looked at and the responses of the surveyed dietitians:

Nutrition-Assessment Practice Activities - the advanced-practice registered dietitian nutritionists (APRDNs) were very skilled at gathering detailed food and nutrition histories in a streamlined and efficient manner. They tended to focus on the following: procedures and treatment, patterns of addiction and weight changes, complementary and alternative medicine, and depression, anxiety and eating disorders. In order to gather information from patients, the dietitians surveyed said they used a combination of motivational interviewing, open-ended questioning, active listening, and redirecting.

Those surveyed felt it was necessary to have an in-depth knowledge of how tests, procedures and their results relate to comorbidities. They felt that advanced knowledge in biochemical data, medical tests and procedures was an extremely important skill set.

Nutrition Diagnosis Practice Activities - the APRDNs felt that nutrition diagnosing required frequent reassessment and nutrition diagnoses need to be comprehensive and relevant.

Nutrition-Intervention Practice Activities - the APRDNs strongly endorsed the need for using a patient- and family- centered approach to education and counseling. They felt that having a strong understanding of what motivates a patient/client and using individualized strategies yielded the best outcomes. They stressed the importance of providing education on complex medical nutrition therapies and making sure to prioritize diet modifications for complex medical situations. Again, many of the APRDNs felt that motivational interviewing was helpful in successfully educating patients.

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As we head into our summer clinical rotations, it's important to recognize that there are many experts in our field and we should look to them for the best ways to administer nutrition care. The RDs surveyed in this study have years and years of experience and it's so beneficial to learn about the ways they do their jobs.

- AP

Mediterranean Diet May Be a Good Choice for a Type 2 Diabetic

In a recent study the Mediterranean diet may be the best option. The Mediterranean diet is a diet that consists of high fruit and vegetable intake along with olive oil as a fat, whole grains are also suggested, meats should consist of fish, seafood and low in red meats. The diet is not high in saturated animal fats which can be common in some diabetic diets. In the study two groups of pre-diabetics, those that were showing signs of diabetes were put on two different diets. One group was put on a low-fat diet and the others were put on a Mediterranean diet. Both groups were on a goal of women on 1,500 kcals and men 1,800 kcals. After a 4 year period neither groups were on any diabetes medication. But after six years the group on only a low fat diet were all put on diabetes medication. The Mediterranean diet group did not go on diabetes medication until 8 years after starting the diet. The Mediterranean diet group also showed signs of "remission" of diabetes which show normal blood glucose levels. This diet can be a good option for a patient with pre-diabetes or a  current diabetic patient. The diet is very well balance and offers a wide variety of foods. 




LN

http://www.reuters.com/article/2014/04/17/us-mediterranean-diet-diabetes-idUSBREA3G2C820140417

http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Tuesday, April 15, 2014

How Accurate is BMI in Measuring Body Fat?


This article discusses the history of BMI and how emerging research is suggesting that it is not the most accurate measure of body fat. Studies have found that people with excess internal body fat can have BMI’s that are on the lower end of a healthy weight range. Also, those with high BMI could have little excess body fat. It also points out how BMI does not take into account age, health conditions, and distribution of body fat. Clinical dietitians need to see the whole picture and relay more on measurements to accurately decide whether or not weight loss is needed. Although the measurements may take more time, it yields far more accurate results. It is also the role of dietitians to explain this to patients and other health care providers who may not fully understand how BMI is calculated and why it can sometimes provide an unreliable number.

 

More information is provided in the link below:


 

 

-AA

Sunday, April 13, 2014

Patient-Practitioner Communication

While flipping through the April issue of the Journal of the Academy of Nutrition and Dietetics, the article in the Topics of Professional Interest section titled “Enhanced Bedside Manner Heals Patient – Practitioner Communication” caught my eye since we are preparing to begin our clinical internship experience. It discusses the importance of practicing effective communication techniques in the clinical setting, as well as communicating as a leader.

In the article, Tony Peregrin highlights the recent program collaboration at Virginia Commonwealth University (VCU) between the medical school and the theater department. VCU’s Standardized Patient Program couples actors trained to play the role of patients with medical students to practice communication in the clinical setting. In a world where so much is done through computers, having the skills to communicate effectively face-to-face is especially vital. Concepts that seem simple, such as standing proximity to a patient, active listening, body language, and gestures/facial expressions, can greatly impact the patient-practitioner relationship both positively and negatively. VCU medical students benefit from these practice simulations by receiving feedback from their “patients” before stepping into the actual clinical environment for the first time.

Associate professor of theater at VCU, Aaron Anderson, PhD, mentioned that role playing isn't meant to train students to be actors in the clinical setting but rather a way to develop empathy. For members of the Academy of Nutrition and Dietetics, resources for practicing or refreshing clinical communication skills are available through the Center of Professional Development. Members of the Academy can even earn a certificate by completing the Leadership Certificate of Training: Developing Your Role as a Leader program.

For Peregrin’s complete article, it can be accessed here:

Peregrin T. Enhanced bedside manner heals patient-practitioner communication. J Acad Nutr Diet. 2014;114(4)529-532.


-SH

Thursday, April 3, 2014

Surge in US Outpatient Vitamin D Deficiency Diagnoses

A study has just been published in the Southern Medical Journal about the increase in Vitamin D deficiency diagnoses in outpatient facilities during 2007-2010. 97% of the diagnoses were for unspecific Vitamin D deficiencies. And about 10% were related to bone disease and osteoporosis. The conclusion of the study was that there needs to be a preventive screening for the deficiency so that it can be treated before it actually starts to effect the patients. The most severe Vitamin D deficiency is rickets which is when the bone does not mineralize and are soft and the skeleton develops deformities. This is definitely something that RDs should be aware of and advocate for patients to be physically active in the sun and consume milk products if they can. Also this could mean that that kidney is having a problem converting vitamin D to its active form in order for the body to use it. What can RDs do to help prevent the increasing diagnoses of Vitamin D deficiency?

-TD

link to article: http://sma.org/southern-medical-journal/article/surge-in-us-outpatient-vitamin-d-deficiency-diagnoses-national-ambulatory-medical-care-survey-analysis/

Sunday, March 30, 2014

Obesity, diabetes pre-programmed in the womb? Fetal response to glucose associated with mother’s insulin sensitivity



I recently came across an interesting article about a study done in Germany that researched the fetal response to glucose and the link it has with the mother’s insulin sensitivity. The study indicates that the risk of obesity and diabetes may start in the womb. Research has already shown that diabetes and obesity in the mother can influence the development of the fetus and the baby after birth. Children who have mothers who are obese or diabetic are at a higher risk for obesity and diabetes also. However, this study was the first that looked at the metabolism of pregnant women following a meal and how that influences fetal brain activity.

The researchers performed an oral glucose tolerance test on 13 healthy pregnant women, and insulin sensitivity was determined by glucose and insulin measurements at 0, 60, and 120 minutes. The response of the fetus was examined by recording fetal brain responses with a magnetoencephalographic device. The results showed that after 60 minutes, women who were more insulin resistant had fetuses that reacted more slowly to the sound test. The findings also support a hypothesis made about 50 years ago by a scientist who researched the link between high insulin levels in the mother and the effects on the fetus. The new research also suggests that chronic hyper insulinaemia in the mothers could correspond to high insulin levels in the fetus, which might induce insulin resistance in the fetal brain.

The conclusion of the study was that “lower maternal insulin sensitivity is associated with slower fetal brain responses.” The research findings provide evidence that insulin resistance may be programmed during fetal development. I found this research interesting because this shows how early the signs of diseases such as diabetes can manifest. Also, the more we know about early development of diabetes and obesity, the earlier we can start to prevent it and/or treat it.

Link to article:
http://www.sciencedaily.com/releases/2014/03/140325190823.htm
-AW

Saturday, March 29, 2014

Quick Fix Diets

Today society is very fast pace and many American's want a quick fix to losing weight. So many people run to their local gym or fitness center and do not see the results they are looking for quickly. This leads many to turn to fad diets to loose weight quickly. A very popular diet is a Ketogenic diet. This diet is recommended by many personal trainers, fitness centers and some doctors offices. The Ketogenic Diet or High protein diet recommends removing carbohydrates from the diet and consuming a high amount of protein and high fat in place of the carbohydrates. So many people may lose weight from this diet quickly, but many may ask is it safe? 
The Academy of Nutrition and Dietetics released a position statement on this popular fad diet. The K-E diet is often a diet that is given through enteral nutrition or by tube feeding. This type of nutrition is given to most often to sustain life to promote and maintain health. The K-E diet can often be given through enteral feedings to help a person lose weight quickly. The risks that can often come along with diets can be seen in the long term and in short term. The Academy gives information on the potential risks with the Ketogenic diet such as kidney damage and gallstones. This does not include other risks along with losing weight rapidly. It is important to stress as a RDN that fad diets are not the answer to life-long health!

http://www.eatright.org/Members/content.aspx?id=6442469945

LN