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

466 comments:

«Oldest   ‹Older   401 – 466 of 466
milad said...



bitcointalk



kodi



lyricstrans



openclassroom



gry-onlin



ardforum



aminoapps



razer



kaskus



tinhte



plantspecialists said...

Your Blog is just amazing and provides good knowledge do sharing such more blogs. I would also like to induce your attention for consult, design, install and maintain indoor and outdoor gardens. Visit: https://plantspecialists.com/

milad said...


newsgood
blogsky
parsiblog
persianblog
kowsarblog
goodnewsnetwork
khabarbaran


milad said...



loxblog
farsiblog
hellonews
nasim
monoblog
avablog
networknews
rozblog
aramblog
blogspot


sutrararta said...

Would-be medical

Would-be medical exec from Iran barred from Canada over alleged ties to Tehran's nuclear program. Ramin Fallah was labeled a security threat because he ...

besayi said...


دانلود زیرنویس فارسی سریال The Falcon and the Winter Soldier 2020 فصل 1


Appslure said...

I have read and really enjoyed it! We are Mobile App Development Company

besayi said...


seforum



iniaturehorsetal



imatepheasanthu



over



hrono



ommunity



fo



gravity



zenstudios


besayi said...


homesteadingt



rkingdog



orum



amilydog



barrelhor



stock



ukclimbin



germanshe



hunting

besayi said...


gfo



gforum



tep



afte



oru



ilykit



ummypet



enretrieve



xerforu

marryann1220 said...

google 3775
google 3776
google 3777
google 3778
google 3779
google 3780

besayi said...


gforstre

gforumta

alpha

rezaeian

gamefa

ilitaykit

uvarshavsko

servinore

xafaclub

besayi said...



gfertalko

apoi

tetopostudip

afunityte

oraftfox

ilyshdotkit

swaqc

enretrietove

ebin

besayi said...


grosportsfo

gtchfab

ssu

onedi

onelyplane

ilyhevekit

umalfak

ve

xllifera

besayi said...


aytoloja

bbs

cruzroja

recipes

zombie

searchgi

weheartit

ycling74

ackhatprotoo

besayi said...


4shared

fan

wikidot

higherle

plesk

mobafir

forexf

radiocut

riberr

besayi said...


eldeng

warriorforum

rme

ostcount

patreon

pbase

ugoodreads

ubisof

producthunt

Lee said...

My Assignment Services will help you in making the decisions as per your requirement. They will provide you with many benefits. The essays and assignments will have relevant information. No need to worry anymore. If your workload is piling up and has to submit your assignment in less time, then you can get Homework Help from My Assignment Services. This will help you in setting up your priorities.

besayi said...


dforum

player

indiatoday

dndbeyond

wordreference

bcmtouring

kvraudio

indiarailinfo

xforum

besayi said...


adblockplu

onderslate

storyweave

wikihow

hicitysport

collinsdictiona

democraticun

rvetteforum

comodo

besayi said...


ranorex

shelledwarrior

msuk

evelopers

bungie

expat

rctech

ozgrid

dpreview

besayi said...


gfgeso

gforooum

tagesep

aftgooge

oroogu

ilykiagest

ummypegoogt

enretriegoogve

xoogerforu

besayi said...


gfooooo

gfogesrum

teoglep

aftgooge

oooglru

ihsshlykit

umagemypet

enretoglrieve

xerfogooru

besayi said...

ggoog

gfomagerum

tegoop

afteoogl

oruoogl

ilykgesit

ummypyjyyet

enretriehhsshshve

xerforumsg

besayi said...


gfhhsho

gforumagagag

tepxhdj

afteagg

oruaayy

ilykitgayay

ummygaypet

enredudutrieve

xerfayyyoru

besayi said...


gfosgggs

gforumgshh

tepaggaga

aftgyyre

ogshru

ilagayykit

ummsgshhypet

enretrhssssieve

xerfggoru

besayi said...




gfoatgg

gforaaggaaum

tepxgg

afteahhh

ortaru

ilykitsgs

ummypetshh

eagieve

xerforufaa

besayi said...


gfogggga

gforumhhshshgk

tepayyyhs

aftejjjjj

orujuuuuuuu

ilykitttraat

ummypetdhhh

enretrievetaatat

xeraggforu

besayi said...


gfoaggg

gforumayyyy

tepattaatath

afteatyy

oruatay

ilykitaggaag

ummypetaggggg

enretrievaggge

xerforuaggg

besayi said...


gfoirrrr

gforuuuuusum

tepaayay

afteaggaagg

oruyyyya

ilykitoooooo

ummyphhhhhjet

enretxxxrieve

besayi said...


work award to Ramin Fallah

Venkatesh Armugam said...

Buy all kinds of Buy Handmade Items online at ArtyCraftz.in

Buy all kinds of Buy Handmade Handicrafts Items online at ArtyCraftz.in

Ashwin Krishna said...

India Assignment Help is the most reliable assignment writing company in India. We pride ourselves in helping Australian University Students to excel in their assignments since 2009.

Ashwin Krishna said...

If you are taking assistance at India Assignment Help directly from experts, then they will be going to cover all aspects of marketing management, including all related subjects and topics. You can get the best solution at the most affordable price by contacting them at any time for Marketing Assignment Help.

Ashwin Krishna said...

India Assignment Help is the most reliable assignment writing company in India. We pride ourselves in helping Australian University Students to excel in their assignments since 2009.

In the beginning, we mentioned how statistics is used in business analytics. As a matter of fact, it is a major force in today’s market practices and business surveys. Our statistics assignment help is made up of experts who can resolve all your queries in this area as well.

CPM Systems Pvt. Ltd said...

If you are an Interior fanatic then this is your chance to seal the deal with the best office furniture Manufacturers. CPM systems have cracked every aspect of delivering the best Office furniture to their clients. Whether it’s strictly time-framed deliveries, precise installations, a wide range of models and designs, or a supportive team of field experts. Our collection goes through rigorous quality control before it is turned over to the clients. Visit our website to get your ideal office furniture manufacturer.

CPM Systems Pvt. Ltd said...

CPM Systems provides its clients the ultimate state of comfort and style that arrives with the union of experience and knowledge and office furniture Manufacturer. Being a reputed name amongst the Top office furniture Manufacturers, CPM Systems has been delivering contemporary and classy office interiors to the community.

Ashwin Krishna said...

I am Glad to share this information with you guys that there are many assignment help services online such as India Assignment Help which offer genuine help as they are stable in the market for more than 10 years. Experience often makes a person or a business skilled. A large team of mathematics experts make this task easy for the students as they take proper responsibility for the assignment of the students.

Ashwin Krishna said...

Thanks for such a valuable information. Some students find it difficult to get through the SOP Writing Help. Due to this, they need assistance from professionals who can aid them in their SOP Writing Help. Writing a statement of purpose is one of the difficult tasks and is considered a challenge for most students. A lot of students fail during writing the statement of purpose format hence they search for a Statement of purpose sample .

Ashwin Krishna said...

Students take assignment help to complete their assignments because of a lack of knowledge and poor writing skills. There are a lot of assignment writing that provide assignment help such as India Assignment Help which are stable in the market for more than 10 years.

besayi said...



p1
p2
p3
p4
p5
p6
p7
p8
p9
p10
p11
p12
p13
p14
p15
p16
p17
p18
p19
p20
p21
p37
p22
p23
p24
p25
p26
p27
p28
p29
p30
p31
p32
p33
p34
p35
p36

besayi said...





p1
p2
p3
p4
p5
p6
p7
p8
p9
p10
p11
p12
p13
p14
p15
p16
p17
p18
p19
p20
p21
p37
p22
p23
p24
p25
p26
p27
p28
p29

Ashwin Krishna said...

Really nice blog thanks for sharing It is right that Homework is an unavoidable task in every scholar’s life. Learners from every stream, university, and college are assigned complex tasks during every semester. These assessments consume a lot of time and require excessive effort. India Assignment Help is an assignment writing provider that comes with various features like on-time delivery, plagiarism free assignment paper and others which have been given below. Additionally, there are few more advantages to contact Homework Help
• A Team of Subject Matter Experts
• Live Session (1 – 1)
• Expert Consultation
• Globally Available
• Turnitin Report

Ashwin Krishna said...

I am Glad to share this information with you guys that There are many management assignment help. services which helps the student to complete their assignment with good quality such as India Assignment Help which has been stable in the market for more than 10 years and is delivering successful solutions handled by the management professionals.

R1se Hluoluo said...

Tempat Sarapan Enak Semarang dapat di temukan dengan mudah dengan menu-menu yg dapat menggugah selera semua orang dengan harga murah. https://Anekasarapan.web.id

Baru mendarat di Semarang dan bingung mau sarapan dimana? Jangan khawatir, Anda datang ke halaman yg tepat. Berikut beberapa tempat sarapan di Semarang.

Sophia Emma said...

Thanks for sharing the Blog Keep Sharing like this. I also recommend visiting lash extension supplies.

CPM Systems Pvt. Ltd said...

Best Sexologist in Delhi NCR by Dr. P.K. Gupta and Sex Treatment Specialist Doctor

Gabriella Jackson said...

I’m impressed, I must say. Really rarely do I encounter a blog that’s both educative and entertaining, and let me tell you, you have hit the nail on the head. Your idea is outstanding; the issue is something that not enough people are speaking intelligently about. I am very happy that I stumbled across this in my search for something relating to this.

Ulule.com
Information
Click Here
Visit Web

Irene Berry said...

The next time I read a blog, I hope that it doesnt disappoint me as much as this one. I mean, I know it was my choice to read, but I actually thought you have something interesting to say. All I hear is a bunch of whining about something that you could fix if you werent too busy looking for attention.

Findery.com
Information
Click Here
Visit Web

Juliany said...

Web Judi Bola Sportbook Online hingga Kini hobi kamu dalam menyukai sepak bola dapat terbantu mengusung eksistensi satu laman bola up-to-date pada internet, dalam mana anda dituntut supaya kemudian berpikir.

Sejumlah netizen terkadang belum tahu hal ini, walaupun sumpama mereka menyadarinya tambah cepat, https://888sport-betting.com maka seluruh yang berhubungan dengan taruhan bola update hendak menjadi pakai untuk dirinya.

visa application form Turkey said...

Attractive component of the material. I just stumbled across your web site and accession capital to say that I really enjoyed your site. With just a few clicks, foreign nationals can apply for a visa application form Turkey from their home. Fill the form with accurate and complete information about the passenger's data.

OfferWorld said...

HI, Great! thanks for sharing awesome info.
Search Google or type a URL

Survey said...

Very good write-up. I certainly love this website. home depot survey

Waseem Uddin - Hyderabadi said...

Excellent article. It is Very interesting to read. I really love to read such a nice article. Thanks! keep rocking.

English to Arabic Translation
English To Urdu Translation
English to Russian Translation
English to Bengali Translation
English to Hindi Translation
English to German Translation
English to French Translation

Legal Translation Company in Dubai said...

United Arab Emirates, Federal Decree-Law No. (34) of 2021
United Arab Emirates, Federal Decree-Law No. (32) of 2021
United Arab Emirates, Federal Decree-Law No. (31) of 2021
United Arab Emirates, Federal Decree-Law No. (30) of 2021
United Arab Emirates, Federal Decree-law No. (29) of 2021
United Arab Emirates, Federal Decree-law No. (28) of 2021
United Arab Emirates, Federal Decree-law No. (27) of 2021

Anonymous said...

Dapatkan bonus turnover setiap harinya dengan deposit ringan dan murah hanya di poker dewa situs yang kami sediakan ini, saya sendiri juga bermain disini internet oleh karena itu saya ingin membagikan rejeki bersama-sama dan kita akan menjadi orang yang berhasil bersama-sama menghasilkan banyak uang karena disini idn poker88 tempatnya orang cari uang dengan mudah dan cepat serta berpenghasilan besar-besaran.

lilia said...

good

makeupsavvy said...

Thanks for sharing this post

GOLI said...

thanks for shared this.
mekardo.com
soft treats for dogs after dental surgery

GOLI said...

thanks for shared this,mekardo is an animal lover.
soft treats for dogs after dental surgery

soft food for dogs after dental surgery

best soft food for dogs after dental surgery

mekardo.com

barron said...

play poker online here and get the benefits
dewapoker
domino88

barron said...

Join di website kami sekarang juga dan dapatkan hadiah menarik lainnya
nagapoker
lapak303 apk

Happy guddu said...

status for whatsapp

Leana Varnon said...

Best and also Least expensive Jabodetabek Private Coaching, our own workers in addition to trainers are available home, placed your study program which enables it to pick any discipline involving analysis ... click https://bimbel-calistung.netlify.app/les-privat-calistung-cakung.html for more details

Rosemarie Lionetti said...

Perhaps you will find a cheaper fee versus table above, be certain again regarding the qualifications with the teacher / Kindergarten teacher recommended for you ... for detail https://ipa-exed.blogspot.com/2022/06/les-privat-ipa-di-pejaten-terdekat.html

Andre Lafauci said...

Executive-Education.id is an expert private tutoring institution in Jabodetabek and it is surroundings which brings students alongside the best teachers ... visit https://privatmurah.vercel.app/les-privat-bogor-murah.html for more details

«Oldest ‹Older   401 – 466 of 466   Newer› Newest»