Kent State Interns

      Since we have a speaker coming from Hattie Larlham Center for Children with Disabilities to our clinical class tomorrow, I thought I would make a post relating to this topic. As part of our assignment, before the speaker we learned BMI and standard CDC growth charts should not be used in children with disabilities. Children in this population can be at the third percentile according to CDC standards for BMI yet still be progressing at a normal growth rate. Yet, this study uses standard weight, height, and BMI measures to assess the nutritional status of mentally disabled children in Egypt. Not surprisingly wasting was documented in 14% of children 6-13 years of age and stunting was reported in 33.5% of the sample population. A redeeming quality of this study, however was tricep skin fold thickness, serum levels of Vitamin A, and plasma levels of copper, zinc, and magnesium were also used to assess nutritional status. It was found magnesium and iron deficiencies were found in alm

Approximately 35% of the US population has prediabetes.  According to the American Diabetes Association, it is estimated that 70% of individuals with prediabetes will eventually progress to type 2 diabetes.  The diagnosis of prediabetes gives health care professionals (including dietitians) the opportunity to identify patients with increased risk for type 2 diabetes and implement interventions that cab delay or prevent type 2 diabetes. Unfortunately this opportunity is often unrecognized.  A nationally representative sample of people with prediabetes found that only 31% had been counseled about exercise, 33% about diet, and 25% about diet and exercise.  And those who had been counseled by their health care provider reported better adherence to diet changes and weight control, had lower LDL and higher HDL cholesterol, and lower BMI. You can read more about the topic in this  article  from the Academy of Nutrition and Dietetics. -KC

Since we are all getting ready for our full time clinical summer rotation, I thought that it may be helpful to learn what a day in the life of a clinical dietitian is really like! I found several blogs, one of a student's experience at a VA hospital, and another of an RD who is studying to become a CDE.  I loved these explanations of the daily activities, because they gave such a realistic view of what to expect.  Lots of charting, but also the opportunity for patient interaction, working with other staff members including the foodservice staff, DTR and other RD's, and many unscheduled things that "pop up".  I especially liked seeing how full the day may be when counseling patients - the RD studying to become a CDE had 14 scheduled appointments on one day!! Basically - this seems like a great baseline of "What to expect", but I still think "Expect the unexpected" are good words to live by this summer! Hope that you all enjoy :) CR Jessie. 

Seeing different ways to educate people on what and how much they are eating is always exciting, as these tips can help us in future practice, too.  I found an article here with a study that looked at a new way for clients to estimate calories in a meal on their own.  The study compared nutrition students and non-nutrition students, their scores on the EAT-26 to weed out outliers, and their anthropometrics as well as their ability to estimate the caloric load of a sample meal using the Think Aloud method.  This method includes talking outloud (verbally) the process of arriving to the total number of calories using perhaps portion sizes or the relative sizes of objects compared to serving sizes; this method is new to nutrition but could be useful in our field due to the thought processes behind eating, food selection, and other introspective behaviors.  The authors concluded that for counseling sessions with limited time, clients could benefit from the Think Aloud method.   --Christi

While not a clinical article, this can apply to counseling and understanding your patients or even ourselves as interns and looking at professional behaviors.  I got linked to this article via email.  While lateness is indeed f rowned upon in most c ircumstan ces, there seems to be some va lidit y behind it.  I think I per so nally can align at times with The Produce r - I know some of yo u can too. I also got "never plan to be on time" out of the article too. Nice, easy read -- e njoy! --Christine P.-- Schupack, A.   (2013).   Overcome your lateness.   Retrieved 2/21, 2013 from http://www.huffingtonpost.com/2013/01/28/always-late-be-on-time_n_2534109.html.

      Antioxidants are beginning to be examined more in the clinical world for their anti inflammatory and potential cancer fighting roles. Quercetin is a flavonoid known to have anti inflammatory and antioxidant properties found in peels of onions and apples. Lately, quercetin has been isolated in supplements to reduce muscle damage and inflammation after strenuous exercise. In this particular study , participants received either a 1000 mg quercetin filled nutrition bar or placebo for  seven days before eccentric exercise and for five days after. Exercise included 24 contractions of the elbow flexors using a modified preacher curl bench. Interestingly, both the treatment and placebo group experienced muscle soreness, strength loss, serum creatine kinase elevations, and arm swelling and it was found quercetin supplementation had no effect on markers of muscle damage or inflammation after eccentric exercise. Furthermore, IL-6 and C-reactive protein levels in the body were not altered re

As we did our case study featuring an adolescent girl, I realized how difficult it could be to get dietary information from that age group or younger.  Sure, you can ask the parents - but they could also tell you healthier foods than were actually consumed.  This article here talks about a new form of dietary recall, the Automated Self Administered 24-hour Diet Recall (ASA-24) that is an online method of capturing this information and was being piloted to 8-13 year olds.  This was contrasted with the traditional human diet interview on the basis of how well foods consumed matched between both interviews.  The researchers concluded that it would be helpful for 8-11 year olds to have parental assistance in using the ASA-24 and that the program needs to be made more user friendly for this age group.  Perhaps when we begin practicing as RD's we might get to use programs similar to this. --Christine P. Source: Baranowski, T., Islam, N., Baranowski, J., Martin, S., Beltran,

Since a lot of us are doing school food service rotations this semester, there is an interesting article in the February edition of the Journal of the Academy of Nutrition & Dietetics about the differences in participation between the School Breakfast Program and the School Lunch Program. The article looks at the feelings of both the parents and the students and it is interesting to see where they agree and disagree. The article can be found on pages 252-257 of the February 2013 journal. JY – 2/16/13.

Research has shown that the treatments used for pediatric cancer often lead to a decline in nutritional status in these young patients.   This decline can then lead to an increased risk of disease-related morbidity and mortality, making this issue very important.   The review article entitled “Malnutrition and Obesity in Pediatric Oncology Patients: Cause, Consequences, and Interventions” delves into the topic of nutrition in pediatric cancer patients and seeks to determine the etiologies of suboptimal nutrition status, as well as its consequences and current treatment strategies.   One thing I learned from this article was that not all pediatric cancer patients are at the same nutritional risk; different cancers and the varying treatments employed in these different cancers lead to vastly different nutritional problems.   Before reading this review, I did not realize that children with certain cancers are at more of a risk for the onset of obesity than undernutrition

Vitamin deficiencies are common with bariatric surgery patients, especially those who receive the Roux-en Y procedure. These patients needed to be closely monitored because even those who are placed on a live long multivitamin routine can experience vitamin deficiencies. This particle article looked at a case of beriberi due to a thiamin deficiency. There is a lack of caloric intake after surgery with most patients consuming between 600-900 calories per day. This is not enough calories for adequate micronutrient intake. Thus there is a need for bariatric patients to be monitored by their doctors and even a registered dietitian to ensure there is not a deficiency. The malnutrition and vitamin deficiencies are an ongoing problem today and with the increase in bariatric procedures, this definitely needs more attention by the healthcare team overlooking the patients' care. --Sarah Carlson 2/11/13 Source: http://journals.lww.com/smajournalonline/fulltext/2009/10000/vitamin_defic

     Since some of my classmates touched on motivational interviewing in the previous posts, I wanted to address behavior change theories in nutrition counseling. This article shows strong evidence for using the cognitive behavioral theory in nutrition counseling. These interventions tended to have the greatest positive effect on individuals with Type II diabetes and hypertension regarding their dietary habits, weight, and cardiovascular/diabetes risk factors. With the cognitive behavioral theory, a client is urged to explore, identify, and analyze dysfunctional patterns of thinking and acting. The client and counselor continually set goals, complete self monitoring in the form of food diaries, develop rewards for meeting goals, manage stress, etc. Interestingly, this article stated few studies exist in the nutrition field demonstrating use of the trans theoretical model, describing a series of cognitive and behavioral steps individuals take to change behavior. With motivational inter

Sorry forgot the link on my last post. The article can be found at http://www.todaysdietitian.com/news/exclusive/0213.shtml JY-1/7/13

This article, published in Today's Dietitian , discusses the benefits of a graduate degree for RD's. The authors Christine Karpinski & Mary Beth R. Gilroy outline the benefits that an advanced degree can bring in regards to salary and the ability to compete for higher management positions as well as in independent practice. They also mentioned the idea that the Academy of Nutrition and Dietetics may soon require a Masters degree to sit for the RD exam. -JY-2/7/13

I found a recent study that surveyed dietetic interns about the use of the Nutrition Care Process in their clinical rotations to see how NCP is being implemented into practice. Around 50% of the dietitians training the interns were using NCP in their clinical care. The authors' believe dietetic interns can serve as a valuable resource to clinical facilities that have not yet began the NCP or in transition.  Students and interns often have the most formal training with the NCP and therefore can help disseminate knowledge and skills by sharing information with preceptors and staff dietitians through assignments like case studies and care plans.  There is a chance that our summer clinical sites won't use NCP so this is something to think about as we get ready for our clinical rotation. Source: Krantz, A., Cotugnam N., & Manning, C.K. (2011) Dietetic interns can serve as a valuable resource for diffusing the nutrition care process into clinical practice.   Topics in Clinic

Since we are talki ng about sever e and non-se vere malnutrition and their respective criteria, I thought I would hit that trend this week.  Addi tionally, in our reading assignment s, we have learned that reference values are for healthy, you ng-middle age adu lts and not for the very old or the very youn g.  This artic le HERE builds and pilots a new screen ing tool called STAMP (Scre ening Tool for the Assessment of Malnutrition in Paediatrics).  The authors noted how quick and easy it was - whic h reminded me of the PG-SGA we have b een work ing with in c lass.  It was pretty successful in the inpatient arena, but more testing is needed to see if community agencies can use it too.  Below is the source if you want to read m ore. Source: McCarthy, H., Dixon, M., Crabtree, I., Eaton-Evans, M. J., & McNulty, H.   (2012).   The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) for use by healthcare staff.