Saturday, February 6, 2010

Supplemental alpha-tocopherol: A Perspective on Approaching an Evidence-based Project


As part of a Continuing Professional Development project with ARAMARK Canada Ltd. at the Toronto Rehabilitation Institute (Toronto Rehab), I reviewed the literature on supplemental α-tocopherol. My objectives were to weigh the potential risks versus benefits of supplemental α-tocopherol in primary and secondary prevention of cardiovascular disease (CVD) to determine specific practice considerations for supplemental α-tocopherol including the type of supplement, dose and duration. This was an opportunity for me to hone my skills using evidence-based methods. As expected, a plethora of literature on this topic existed, so I focused on randomized controlled trials (RCTs).

Reading, critiquing, and comparing the many papers that exist on the topic was time consuming, but necessary. Some studies looked at α-tocopherol alone, while others looked at α-tocopherol in combination with other antioxidant supplements. Studies were inconsistent in terms of dose, unit of measure (mg versus IU) and source (natural versus synthetic). I discovered there are specific conversion factors to use depending on the unit of measure, as well as the source (natural or synthetic). Taking the Dietary Reference Intake (DRI) course in the past proved helpful as I was able to easily retrieve required information on α-tocopherol.

Working on such a large project really put my organizational abilities to the test. Initially feeling overwhelmed, I decided to arrange the stack of papers. Primary prevention papers were filed in one binder and secondary prevention in another. Within the secondary prevention group, where I devoted most of my time, I compartmentalized further. For example, the outcomes of short term trials (under five years) were examined separately from studies longer than five years. Within these groups, I looked at the dose and type of supplement (natural versus synthetic) and made the necessary conversions.

I highly recommend reading Deborah (Boyko) Wildish’s chapter on micronutrient supplementation (Wildish, 2008), a resource that helped me immensely in my critique.

Factors considered for each article:

  • Population being studied
  • Type of chronic disease(s) or conditions the participants experienced
  • Form of supplemental E
  • Dose and timing (i.e., when was it administered)
  • Study duration
  • Inclusion of other antioxidants e.g., vitamin C, β-carotene
  • Outcome measures

The checklist (p. 190) details factors impacting the strength of study design and quality of evidence.

Keeping to a schedule was paramount for completing such a large project. When I was away from the task for an extended period, I found I wasted valuable time simply reviewing what I had done. The next time I take on such a project, I plan to consistently devote a few hours each week to keep the project alive and the momentum flowing.

I highly encourage involving members of the interprofessional team. I liaised with our program physician, pharmacist and other RDs on issues related to α-tocopherol. Our staff librarian was most helpful in assisting me with the literature search and in obtaining journal articles. This was a huge time saver!

Project Conclusions

For Primary Prevention: No benefits or risks reported with 20-660 IU/d for three to 10 years. Thus, not enough evidence to support recommending supplemental α-tocopherol for primary prevention of CVD.

Secondary Prevention: Equivalent evidence reporting both risk and benefit associated with 22.5 to 800 IU/d for 1.4 to 9.4 years, and increased risk of mortality observed with α-tocopherol supplementation >150 IU/day. It was questionable whether lower doses offered any benefit. More research is required. Therefore, supplementation with vitamin E is NOT recommended for secondary prevention of CVD.

The experience of completing this project left me with several salient points of learning. Firstly, studies generally are not designed to measure treatment risk because inflicting potential harm on humans is unethical. Thus, whenever risk emerges in a study, even if small, it may be more serious than reported because the researchers focused on treatment benefits. Secondly, I learned that you must have a keen interest in your topic to sustain your interest. Finally, there must be practical application of your findings to your daily practice with clients and colleagues. Sharing the results of project work communicates our expertise to colleagues. Not only is this self-empowering, but it helps raise the profile of RDs, and fosters interprofessional relationships.


REFERENCES

Wildish DE. (2008). Addressing clinical queries for micronutrient supplementation in the management of diseases and medical conditions: What can I tell my patient? In: Yoshida T, Ed. Micronutrients and Health Research. Publishers, Inc.: 181-205.

Other references available upon request.


CONTACT:
Maria Ricupero, RD, CDE
ARAMARK at Toronto Rehab
T: (416) 597-3422 (5239)
E: ricupero.maria@torontorehab.on.ca

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راه های یافتن بهترین دکتر بواسیر, پزشک بواسیر, متخصص بواسیر یا هموروئید با رشد روزافزون فضای مجازی کاری سخت نیست. تقریبا همه دکترها و پزشکان متخصص بواسیر در اینترنت برای خود وب سایتی دارند. با مراجعه به آنها و بررسی سوابق و کارنامه پزشکان می توان بهترین دکتر بواسیر, پزشک بواسیر, متخصص بواسیر یا هموروئید را پیدا کرد. پس بدون هیچ نگرانی و خجالتی با دکتر بواسیر, پزشک بواسیر, متخصص بواسیر یا هموروئید که انتخاب کرده اید تماس بگیرید و مشکل خود را با وی در میان بگذارید. مطمئن باشید که بهترین نتیجه را خواهید گرفت و عمری با خیال راحت و بدون درد سپری خواهید کرد.
روش های جراحی بواسیر
یکی از روش‌های جراحی بواسیر، استفاده از هموروئیدکتومی است. در این روش، برجستگی های ایجاد شده در اطراف مقعد تکه تکه می شود و با کوچک کردن آنها، بواسیر درمان می شود.
ممکن است برای این عمل جراحی بواسیر از بیهوشی موضعی فقط در ناحیه ای که مورد نیاز است، استفاده شود. البته بیهوشی موضعی در حالت های خفیف به کار می رود و در مواردی که وضعیت حادتر است نیاز به بیهوشی عمومی است که کل بدن به خواب می رود. معمولا روش هموروئیدکتومی به صورت سرپایی انجام می شود و معمولا در همان روز عمل می توانید به خانه بروید.
هزینه جراحی بواسیر با لیزر به عواملی متععدی بستگی دارد که هر یک از آنها در بالا و پایین رفتن هزینه های درمان نقش مهمی دارند.
دردرمان بواسیر با لیزر نیازی به بیهوشی نیست و عوارض آن را هم نخواهید داشت که هر یک از این موارد در درمان جراحی هزینه های متفاوتی دارند. نکته پایانی اینکه تا زمانی که به صورت کامل معاینه نشدید, نمی توان درباره نوع درمان و هزینه آن حرفی زد. بسیاری از بیماران با دکتر درد(drdard.ir) تماس تلفنی برقرار می کنند و از پشت تلفن می خواهند هزینه درمان را مشخص کنیم، در صورتی که این کار غیر ممکن است.
دو مدل مختلف لیزر بواسیر
روش های لیزر بواسیر با لیزر دارای دو روش اصلی است. که بهترین روش برای شما را پزشک با توجه به نوع بواسیر تان توصیه می کند. پس با استفاده از لیزر می توانید به دو روش بواسیر خود را درمان کنید.
روش اول استفاده از اشعه درمانی IRC
در این روش که برای بواسیر درجه یک و دو مناسب است، بالشتک های التهابی اطراف مقعد با کمک اشعه IRC حذف می شوند. این روش درد و خونریزی ندارد و نتیجه آن زودتر خود را نشان می دهد.
روش دوم استفاده از لیزر CO2
از این روش برای درمان بواسیر درجه سه و چهار استفاده می شود.در بواسیر درجه سه و چهار رگها گشادتر شده و معمولا از داخل رکتوم به بیرون کشیده می شوند، پس با این روش تمام زائده های بیرون آمده از مقعد با کمک لیزر CO2 قطع می شوند و چون عمل برش با لیزر انجام می شود، بافت های اطراف بالشتک ها هم آسیبی نمی بینند.

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amc stars said...

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عکس پروفایل پسرانه شیک و خاص

عکس پروفایل زمستانی دخترانه

عکس پروفایل خاص دخترونه

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sam said...

تابلو تبلیغاتی لایت باکس ها نقش مهمی در حوزه تبلیغات محیطی و بازاریابی دارند. یکی از بزرگ‎ترین امتیازات نسبت به رقیبانش، استفاده از منبع نوری است که از پشت به آن تابیده می‎شود.
لایت باکس پارچه ای
لایت باکس کریستالی
لایت باکس مگنتی
لایت باکس اسنپ فریم
لایت باکس تبلیغاتی

فروشگاه اینترنتی هپی لند said...

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dadehkavy said...

گروه کارخانجات سرزمین شاد (هپی لند) در سال ۱۳۸۵ در زمینه لباس کودک فعالیت خودش را آغاز نود. این شرکت با استفاده از مدرن ترین ماشین آلات دوخت، بهترین متخصصین و بهترین مواد اولیه توانست به سرعت پیشرفت نماید و نام برند هپی لند به سرعت بر زبان ها افتاد. همینطور این برند تنها نامی آشنا در ایران نیست بلکه این برند توانسته نام خود را به آن سوی مرزها ببرد.
خرید لباس

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محصولات گروه کارخانجات سرزمین شاد با عنوان برند روح (ROOH) آلمان توانسته وارد بازارهای بین المللی شود. این شرکت همواره کوشیده است با ارتقاء کیفیت و همینطور کمیت محصولات خود با استاندارهای روزی جهانی در بازارهای ایران، ترکیه، آلمان و … شناخته شود. این مجموعه بالغ بر ۵۰ شعبه در سراسر کشور راه‌اندازی نموده است.

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dadehkavy said...


استاد وبیکی از تخصصی ترین وب سایت هایی است که در حوزه طراحی وب سایت ودیجیتال مارکتینگ به فعالیت می پردازد. اعضای تیم استاد وب متشکل از افرادی بسیار با تجربه در حوزه های تخصصی خود می باشند؛ که در کنار یکدیگر تیم بسیار قوی را تشکیل داده اند. تیم استاد وب در پارک علم و فناوری استان گیلان واحد آستانه اشرفیه حضور دارد و در زمینه های مختلف دیجیتال مارکتینگ از جمله سئو ، کسب و کار اینترنتی، بازاریابی اینترنتی
و طراحی وب سایت به فعالیت می پردازند.
بخش مهمی از فعالیت تیم استاد به شکل طراحی وب سایت در گیلان می باشد که به عبارتی شامل:

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dadehkavy said...

این تیم متخصص و قوی در زمینه سئو و بهینه سازی وب سایت ها فعالیت بسیار گسترده ای دارد و تجربه بسیار ارزشمندی در طول سالیان با کسب و کارهای متفاوت به دست آورده است و به تمامی استانداردها و اصولی که در زمینه سئو و ارتقاء رتبه وب سایت در گوگل مورد نیاز است اشراف دارد.
به تازگی تیم استاد وب در زمینه بازاریابی محتوا و بازاریابی اینترنتی و سئو شروع به آموزش کرده است. در مصاحبه‌ای که با مدیریت تیم استاد وب داشتیم در این رابطه چنین گفت:
در شمال کشور و خصوصاً گیلان، در زمینه سئو ، بازاریابی اینترنتی و بازاریابی محتوا حقیقتاً دچاره فقر دانش و متخصص هستیم. زیرا حقیقتاً به شکلی که در کلان شهری مانند تهران نیازمند افراد متخصص در این حوزه بوده‌ایم؛ گیلان چنین نیازی نداشته بنابراین تعداد افراد متخصص در این حوزه محدود است. ما احساس کردیم که وظیفه ما در شمال کشور این است که دانش و تجربه خود را در این زمینه با همشهریان خود در میان بگذاریم تا به ارتقاء مهارتهای دیجیتال مارکتینگ و کسب و کار اینترنتی استان گیلان کمکی هر چند کوچک کرده باشیم.
امیدواریم که تیم استاد وب به هدف ها و پیشرفت های بسیار بیشتری در زمینه تخصصی خود برسند و افراد متخصص و حرفه ای بسیاری را در این مسیر پرورش دهند

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monajatcarpet said...

سجاده فرش
فرش سجاده ای
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فروش اینترنتی فرش سجاده ای
فرش سجاده ای نگین
فرش سجاده ای محرابی

monajatcarpet said...

سجاده فرش
فرش سجاده اي
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فروش اينترنتي فرش سجاده اي
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monajatcarpet said...

گلیم فرش ماشینی

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monajatcarpet said...

گلیم فرش ماشینی

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انواع گلیم فرش ماشینی

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