tag:blogger.com,1999:blog-76340301453007293602024-03-19T04:58:07.336-04:00DC Practice BlogPRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.comBlogger29125tag:blogger.com,1999:blog-7634030145300729360.post-45103538521416018772010-08-04T13:17:00.003-04:002010-08-04T13:57:22.129-04:00Predictive Energy Equations: Which One to Use?<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 12"><meta name="Originator" content="Microsoft Word 12"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5Csuzanne%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml"><link rel="themeData" href="file:///C:%5CDOCUME%7E1%5Csuzanne%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx"><link rel="colorSchemeMapping" href="file:///C:%5CDOCUME%7E1%5Csuzanne%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml"><!--[if gte mso 9]><xml> 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<br /><span style=";font-size:100%;color:#000000;" ><o:p></o:p></span></p> <p class="Pa5" style="margin-bottom: 6pt;font-family:verdana;"><span class="A12" style="font-size:100%;">Dietetic interns challenge us to keep our practice current. The question of what predictive energy equation to use in clinical practice was a recent example of how our roles as educators linked to our need to keep current. Fraser Health (FH) interns recognized their preceptors had different approaches to calculating estimated energy needs for their patients and wondered how something so core to dietitians’ daily activities could be so varied in practice. A poll of Canadian dietitians and a literature review provided perspectives on the use of predictive energy equations.
<br /></span></p><p class="Pa5" style="margin-bottom: 6pt;font-family:verdana;"><span class="A12" style="font-size:100%;">Indirect calorimetry (IC) is the ‘gold standard’ for calculating energy requirements. Several barriers prevent routine measurements on patients including lack of a metabolic cart or personnel to operate equipment, and the impracticality of completing repeated measures on every patient who requires an energy calculation. Consequently, dietitians rely on predictive energy equations to estimate patients’ energy needs. </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa5" style="margin-bottom: 6pt;font-family:verdana;"><span class="A12" style="font-size:100%;">Over 200 predictive energy equations have been published in efforts to accurately predict energy needs (MacDonald and Hildebrandt, 2003; Ireton- Jones, 2005). No equation has consistently proven to be accurate in hospitalized individuals in acute or critical care. Inaccuracies are introduced due to controversy over which weight to use, the limited number of validation studies done, and the homogeneity of reference populations used when establishing the formulae, amongst other variables (Frankenfield et al., 2005; Fabiono et al., 2009; Walker and Heuberger, 2009). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa5" style="margin-bottom: 6pt;font-family:verdana;"><span class="A12" style="font-size:100%;">An e-mail poll in October 2009 to members of the Dietitians of Canada (DC) Clinical Nutrition Managers’ Network yielded a list of the equations used by at least one dietitian at each of the 16 responding sites: 13 sites used Harris Benedict (HB); eight used the American College of Chest Physicians’ equation (25kcal/kg); six used Mifflin-St Jeor; five used one of the Ireton-Jones’ equations; and two used one of the Penn State equations. These results were consistent with practices worldwide (HB remains the most frequently-used formula (Fabiono et al., 2009)), and the varied practices that the FH dietetic interns had noticed. </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa5" style="margin-bottom: 6pt;font-family:verdana;"><span class="A12" style="font-size:100%;">The e-mail poll also yielded information on which weight (actual, ideal, or adjusted) is used in energy calculations. Four sites used actual weight only and 12 sites used either actual or adjusted weight depending on the individual case. Most sites adjusted body weight using a 25% factor (based on a 1984 American Dietetic Association publication as referenced in Krenitsky, 2005). Other sources recommended a 50% factor (Barack et al., 2002; Krenitsky, 2005). The use of adjusted body weight is not well supported (Barack et al., 2002; Ireton-Jones, 2005; Krenitsky, 2005). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa7" style="margin-bottom: 4pt;font-family:verdana;"><span class="A12" style="font-size:100%;">The following points summarize the support for the predictive energy equations with graded evidence-for-use in clinical practice: </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b>Harris-Benedict (Harris and Benedict, 1919): </b></span><span class="A12" style="font-size:100%;">Not sufficiently accurate to be used in the critically ill (Grade I evidence) (Frankenfield et al., 2007) Use actual body weight (Walker and Heuberger, 2004; Krenitsky, 2005). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b>American College of Chest Physicians (Cerra et al., 1997): </b></span><span class="A12" style="font-size:100%;">Use 25-30 kcal/kg actual body weight for the nonobese critically ill (Grade IV and V evidence). Use 11-14 kcal/kg actual body weight or 22-25 kcal/kg ideal body weight for the obese critically ill (Grade III evidence) (McClave et al., 2009). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b>Mifflin-St Jeor (Mifflin et al., 1990): </b></span><span class="A12" style="font-size:100%;">Best predictor of energy needs in healthy nonobese and obese adults (Frankenfield et al., 2005). Use actual body weight (McClave et al., 2009). Not recommended in the critically ill (Grade V evidence) (Frankenfield et al., 2007). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b>Ireton Jones et al. (1992): </b></span><span class="A12" style="font-size:100%;">Most accurate in young and obese adults compared to other populations. Insufficient data to reject the equation (Grade III evidence supporting its use) (Frankenfield et al., 2007; Walker and Heuberger, 2009) </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b>Penn State 1998 and 2003 (Frankenfield et al., 2004): </b></span><span class="A12" style="font-size:100%;">May use 1998 equation for obese, critically ill ventilated patients (Frankenfield et al., 2005). May use 2003 equation for nonobese critically ill patients (Walker and Heuberger, 2009) (Grade III evidence) (Frankenfield, et al., 2007; Walker and Heuberger, 2009). </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Default" style="margin-bottom: 8pt; line-height: 11.05pt;font-family:verdana;"><span class="A12" style="font-size:100%;"><b><span style=";color:#000000;" >Swinamer (Swinamer et al., 1987): </span></b></span><span class="A12" style="font-size:100%;"><span style=";color:#000000;" >May use for nonobese critically ill patients (Grade III evidence) (Frankenfield, et al, 2007; Walker and Heuberger, 2009). </span></span><span style=";font-size:100%;color:#000000;" ><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;">Even with an accurate predictive equation, obtaining goal intakes is often hindered by delays in establishing feeding access, enteral feed intolerances, and feedings that are held for tests. Our efforts should go toward achieving goal tubefeeding rates and maximizing oral intake regardless of what equation is used. Further, monitoring markers of feeding adequacy including laboratory measures, weight, ventilator weaning, and wound healing allow us to adjust energy goals as appropriate. </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa7" style="margin-bottom: 4pt;font-family:verdana;"><span class="A12" style="font-size:100%;">Based on the results of our survey and literature review, we can have confidence in reporting to our interns that there is more to learn before setting standards for estimating energy needs in hospital inpatients. We use these teaching moments as opportunities to discuss the concept of evidence-based practice using best available research, clinical expertise, and a patient-focused approach to guide decision-making to provide the best possible patient care. </span><span style="font-size:100%;"><o:p></o:p></span></p> <p class="Pa4" style="margin-bottom: 5pt;font-family:verdana;"><span class="A12" style="font-size:100%;">A summary chart of the origins and evidence on predictive energy equations is available on request. </span><span style="font-size:100%;"><o:p></o:p></span></p>
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<br /><p class="MsoNormal" style="font-family:verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact
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<br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Tamar Kafka, RD, MSc
<br />Dietetic Internship Coordinator/Research Dietitian
<br />Fraser Health
<br />New Westminster BC
<br /><span style="font-size:85%;">E: <a href="mailto:Tamar.Kafka@fraserhealth.ca">Tamar.Kafka@fraserhealth.ca</a></span></span></span></p>
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<br /> PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com1320tag:blogger.com,1999:blog-7634030145300729360.post-22980248025318337032010-07-21T14:00:00.005-04:002010-07-23T11:25:16.258-04:00My Food Service Experience as an Intern<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwmresWgQTlRsaA_ArX1UvF4RiieOAjuur2f7PQhkWP_FeMxI-xd7IiO8F7OxJiqAAf5Dc7M2gwG8pSSyZDP7UC4zZUqc2MV48X-yZKH6zSeS4aiQoo_AkD8Wci5GskOS01ITRWtegvrr0/s1600/cafeteria.jpg"><img style="float: right; margin: 0pt 0pt 10px 10px; cursor: pointer; width: 200px; height: 163px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwmresWgQTlRsaA_ArX1UvF4RiieOAjuur2f7PQhkWP_FeMxI-xd7IiO8F7OxJiqAAf5Dc7M2gwG8pSSyZDP7UC4zZUqc2MV48X-yZKH6zSeS4aiQoo_AkD8Wci5GskOS01ITRWtegvrr0/s200/cafeteria.jpg" alt="" id="BLOGGER_PHOTO_ID_5497123066789821138" border="0" /></a><br />When I began the internship component of the Masters of Science in Foods and Nutrition program in May 2009 I was excited to start with my Food Service (FS) rotation. I felt confident in my skills in this area and was ready to apply what I had learned about Patient FS while at school. On the first day of the placement my preceptor told me that my major project was in retail. WHAT? Yes, that was exactly my reaction. Of course, I appeared calm and tried not to show my emotions. I had no experience in retail and had been prepared for projects in Patient FS…. what was I to do?<br /><br />My project was to revamp the menu for the summer and include nutritional analyses of the items so that customers could make better food choices. Being unsure how to go about this, I decided to look at survey returns from cafeteria customers. These revealed interest in the nutritional content of foods offered, and in healthier entrees. To increase revenue and attract more customers, we decided to include entrees that were less expensive so that those who brought lunch from home would consider purchasing a cafeteria meal instead. I created a three-week summer menu with healthier entrees including low-value entrees, and high-end entrees to meet the varying needs of customers who were mainly hospital staff. We completed nutritional analyses of all entrees to identify those that could be labelled low fat (less than 10 g/serving), low sodium (less than 500 mg/ serving), or as a source of fibre (2 g or more/serving). I identified top selling items on the existing menu to retain, searched for lighter, summer-type foods, and explored trends in the food industry (e.g., the Mediterranean influence).<br /><br />While working on this project, I realized that the experience and knowledge I gained would be the same whether developing a patient or cafeteria menu. Synthesizing the items into a 21-day menu cycle was the most critical part of this project. I made sure there was variety and that there were vegetarian choices, that side items (vegetable and starch) would look and taste good with the entrees, and I considered the labour available at lunch versus dinner. I also worked on eliminating my own biases when choosing the recipes, realizing that people have different tastes and preferences.<br /><br />I had to determine who was going to be involved in this project, to whom I could delegate tasks, whose help I would need, who would be affected by the changes, and how we could promote the summer menu. I learned there are many parties involved. The Purchaser had to change ordering and search for new items through Sysco. I worked with her to determine items we had, items to discontinue, possible substitutes, and amounts to order. I also worked closely with the cafeteria Team Leader to determine labour needed to produce the new recipes. We worked on cost and selling prices and promoted the new menu through posters, newsletters and samples.<br /><br />Educating the cooks on the importance of following the recipes was interesting. Not following recipes would change the nutritional value of the menu items, and invalidate the health symbols I had created for each item. I realized I had to slow down and work one-on-one with each cook. I identified a champ, one of the cooks who was supportive and motivated to make changes. He was key to getting the other cooks onboard. Two activities that helped encourage the chefs to follow the recipes were a “Chef of the Day” signature spot on the daily menu where the day’s cook signed off that the items met the nutrition criteria, and having a weekly Chef’s Special. They loved signing off the menu, particularly those who loved being ‘out front’ and showing off their talents and names. The Chef’s Special provided opportunities for the cooks to showcase their creativity and passion for cooking.<br /><br />I learned that networking and talking to colleagues is one of the greatest sources of information since there is not much literature pertaining to Food Service Administration. Thanks to Dianne Steele, the Food Service Manager at Trillium Health Centre (THC) and my preceptor during the placement, I had the opportunity to learn about menu planning and implementation. Thanks also to John Del Prado, the cafeteria Team Leader, who was a great asset. I got to see how everyone’s roles in the nutrition department, Aramark, and the overall organization fit together. This was the ‘big picture’ that sometimes, as interns, we don’t get to see.<br /><br /><p></p><br /><p class="MsoNormal" style="font-family:verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Dahlia Abou El Hassan, BASc, MScFN (C)<br />Master of Science in Foods and Nutrition program (Internship Stream)<br />Brescia University College - University of Western Ontario<br />London ON<br /><span style="font-size:85%;">E: <a href="mailto:dabouelh@gmail.com">dabouelh@gmail.com</a></span></span></span></p><br /><br /><p class="MsoNormal" style="font-family: verdana;"><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com424tag:blogger.com,1999:blog-7634030145300729360.post-9444367394997709722010-07-12T10:40:00.006-04:002010-07-14T13:06:39.301-04:00Studying Food Skills: A Public Health Perspective<span style="font-weight: bold;">Why are food skills important? </span><br /><br />Food skills are necessary for the provision and preparation of foods for ourselves and our households. As dietitians, we speak the language of food skills in our professional work. In Practice - Fall 2007, Christine Chou asked "Where have all the foodies gone?", noting prophetically that focus on the science and therapeutic role of food could be at the expense of its soul. Well, I am grateful to see more foodie dietitians baring their souls and moving "beyond nutritionism" (Practice - Winter 2009). Without food skills, I believe people surrender many choices for what they eat, becoming increasingly dependent on what the food industry provides. In Canada, our food supply is the primary driver of our nation's growing prevalence of obesity, afflicting ever-younger individuals in the population (Slater et al., 2009). Everyone, from an early age, needs to develop good food skills, to be competent and self-reliant, able to follow Michael Pollan's good advice to "eat food, not too much, mostly plants" (2008).<br /><br /><span style="font-weight: bold;">Focus on food skills in Ontario </span><br /><br />In the Ontario Public Health Standards (2008), Health Units are required to provide ‘opportunities’ for food skill development among priority populations. There is however, no published research available that describes the level of food skill among individuals within our communities, though many of us, in addition to the media have bemoaned the ‘de-skilling’ of our population. In Fall 2008, Region of Waterloo Public Health had the opportunity to include two pages of questions about food skills and food activities in the Waterloo Region Area Survey conducted by the University of Waterloo Survey Research Centre. The results of this cross-sectional, random survey from 703 adult respondents aged 18 years and over gave us a snapshot of self-reported food skills and kitchen activities within the general adult population of Waterloo Region. The research findings were presented on January 20, 2010 via a Fireside Chat through CH-NET entitled "Food Skills of Waterloo Region Adults" - the slides and podcast are available at www.chnet-works.ca. A report by the same title is now available on our Public Health website at www.region.waterloo.on.ca/ph (under Resources - Reports and Fact Sheets; topic-specific - Food). While there will certainly be differences between communities, I believe this data provides a baseline description of Ontarians' (perhaps Canadians'?) reported food skills.<br /><br /><span style="font-weight: bold;">Food skills of Waterloo Region Adults </span><br /><br />Based on responses to 13 food skill questions, the prevalence of ‘good’ food skills for everyday kitchen activities ranged between 64.6 - 93.5%, with fewer adults reporting ‘good’ skill in food preservation (freezing/ canning). Data were analysed to examine differences in skills by gender, age and household incomes. Information was also compiled about the amount of time taken to prepare the ‘main meal’ in the home, the frequency of ‘from scratch’ cooking, and the relationship between gardening and food preservation skills.<br /><br style="font-weight: bold;"><span style="font-weight: bold;">How shall we proceed? </span><br /><br />The challenge for us as dietitians remains; we must regard our own skills with food as an important continuing education activity, and we need to consider what we know about the food skills and food activities of our audience/ clients as we plan programs and services. Some of the questions we can ask are: WHO might benefit most from developing their food skills?; HOW do we facilitate the provision of opportunities for food skills in our communities?; WHAT is the best way for the target learners to learn; and WHERE and WHEN would this happen? Certainly, we can all begin in our own homes. Children need to learn and develop skills with food from an early age. When people develop food skills, they increase their eating choices, relying less on industrial processing or restaurant offerings. To promote health, to stem the rising tide of obesity and the increased burden on healthcare systems, everyone needs food skills - how to choose it, how to prepare it, and how to eat it.<br /><br />For more information and discussion about food skills and our research at Region of Waterloo Public Health, check out the posted materials and/or contact us.<br /><br /><span style="font-weight: bold;">REFERENCES </span><br /><br />Ontario Ministry of Health Promotion (2008). Ontario Public Health Standards. Available at: <a href="http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/index.html">www.health.gov.on.ca/english/providers/ program/pubhealth/oph_standards/ophs/index.html</a><br /><br />Slater J, Green CG, Sevenhuysen G, Edginton B, O’Neil J, Heasman M. (2009). The growing Canadian energy gap: More the can than the couch? Public Health Nutrition, 12(11): 2216-24.<br /><br />Pollan M. (2008). In defense of food: An eater's manifesto. The Penguin Press: New York, NY.<br /><br /><p></p><br /><p class="MsoNormal" style="font-family:verdana;"><span style="font-family:verdana;font-size:130%;"><strong><span style="COLOR: rgb(51,102,102)">Contact<br /></span></strong></span><br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Pat Vanderkooy, MSc, RD<br />Public Health Nutritionist<br />Waterloo ON<br /><span style="font-size:85%;">E: <a href="mailto:vpat@region.waterloo.on.ca">vpat@region.waterloo.on.ca</a></span></span></span></p><br /><br /><p class="MsoNormal" style="FONT-FAMILY: verdana"><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com496tag:blogger.com,1999:blog-7634030145300729360.post-71978367290116644402010-07-05T14:57:00.017-04:002010-07-07T15:53:22.461-04:00From Field to Table Spring Supper in Manitoba<p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">Most, if not all, Canadian dietitians know that March is Nutrition Month. Sometimes we start planning activities months ahead of time; sometimes we begin preparations later than is ideal. This year at the end of February, a group of rural dietitians in southern Manitoba (MB)* were inspired to jointly plan a community-minded supper that would showcase local foods in keeping with the 2010 theme <i>From Field to Table</i>. </span></span><span style="font-size:10;color:black;"><?xml:namespace prefix = o /><o:p></o:p></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">The seed was planted when two of us attended the session <i>From Farm to Cafeteria </i>at the <i>Growing Local, Getting Vocal Conference </i>in Winnipeg in February 2010 (<a href="http://food.cimnet.ca/cim/43C1_4T97T3T7.dhtm">http://food.cimnet.ca/cim/43C1_4T97T3T7.dhtm</a>) and started to dream. We quickly rallied interest in other dietitians, and began to develop vision and structure for the event. The first priority was identifying a venue. Although we live in four different communities, we agreed to focus our energies and pick one town to host the supper. Luckily, determining the site proved easier than anticipated as a number of venues had limited or no availability. As we were interested in partnering with a chef, when we contacted the chef and the food manager at the local golf and country club in Morden (a fairly new building with country charm and a fabulous view), they were very receptive and enthusiastic. They had been talking about doing something similar for a while! They were on board from the beginning, willing to provide a lower plate cost than their standard price, and brought their event planning expertise and support staff as part of the package. This was a no-muss and less-fuss solution that was particularly enticing given the short timelines. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">Local food champions in surrounding communities and other stakeholders were invited to participate in the initial planning meeting. The meeting was also advertised on a public community website. Two dietitians agreed to share the leadership role. The three-fold purpose of the event was identified right from the start: To create awareness of local food opportunities and issues in south central MB; to build local food partnerships within the area; and to celebrate Nutrition Month. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">We divided into sub-committees: Promotion; Program; Menu/Food; and Vendor/ Producer Booths. We finalized the date (March 25) early to optimize promotion opportunities and to secure program participants, vendors, and volunteers. Due to time constraints, the lead dietitians developed committee work plans for key tasks and timelines prior to the first meeting. Two of the committees (Promotion; Program) were comprised of dietitians only. The Menu/Food committee included the chef, food manager, and a lead dietitian; the Vendor/Producer committee work was executed by two dietitians and a community person. The core planning group met three times prior to the event including a brief meeting on the day prior to the supper. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">Key components of the event included: 1) A simple yet elegant menu accompanied by donated fresh breads; 2) local food producers or suppliers set up at stations around the dining area with additional displays from Manitoba Agriculture, Food and Rural Initiatives; Dietitians of Canada; and Food Matters Manitoba (FMM); 3) MC duties by a representative from FMM; she also shared information and quizzed diners for prizes; 4) harp and cello music; 5) open microphone session; and 6) door prize tickets. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">We charged $20 per meal in advance and $25 at the door (only seven people paid at the door!). Attendance was 145 people, almost 50% more than the food manager had predicted based on past experience. We went over-budget by about $300, mainly due to printing costs, a large number of complimentary and discounted meals (to volunteers and producers), and under-estimating revenue in the door prize area.<o:p></o:p></span></span></p><p class="MsoNormal"><span class="A3"><span style="font-size:10;"><o:p></o:p></span></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">A contingency plan in place prior to the event ensured that the loss was covered. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa17" style="MARGIN-BOTTOM: 4pt"><span class="A3"><span style="font-size:10;">The following groups of participants expressed high levels of satisfaction with the evening: </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><ul><li><span style="font-family:Symbol;font-size:10;color:black;"><span style="font-size:0;"><span style="FONT: 7pt 'Times New Roman'"></span></span></span><span class="A3"><b><span style="font-size:10;">Dietitians: </span></b></span><span class="A3"><span style="font-size:10;">Through great teamwork and focusing on a shared goal, we attained a feeling of accomplishment and community. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span style="font-family:Symbol;font-size:10;color:black;"><span style="font-size:0;"><span style="FONT: 7pt 'Times New Roman'"></span></span></span><span class="A3"><b><span style="font-size:10;">Vendors/Producers: </span></b></span><span class="A3"><span style="font-size:10;">Although we did not permit sales on site, the presence of the producers in the banquet room facilitated a lot of interest and interaction from diners. The key times for visiting the booths were during the appetizer course and at the end of the meal. Many said the evening far exceeded their expectations. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span style="font-family:Symbol;font-size:10;color:black;"><span style="font-size:0;"><span style="FONT: 7pt 'Times New Roman'"></span></span></span><span class="A3"><b><span style="font-size:10;">Restaurant: </span></b></span><span class="A3"><span style="font-size:10;">The food manager and chef expressed keen interest in partnering again to plan a similar evening. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span style="font-family:Symbol;font-size:10;color:black;"><span style="font-size:0;"><span style="FONT: 7pt 'Times New Roman'"></span></span></span><span class="A3"><b><span style="font-size:10;">Master of Ceremonies: </span></b></span><span class="A3"><span style="font-size:10;">She noted the supportiveness of our community and the breadth of our local resources. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span style="font-family:Symbol;font-size:10;color:black;"><span style="font-size:0;"><span style="FONT: 7pt 'Times New Roman'"></span></span></span><span class="A3"><b><span style="font-size:10;">Diners: </span></b></span><span class="A3"><span style="font-size:10;">Many individuals took time to compliment us on all aspects of the supper. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></ul><p></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">What conditions were favourable? Since there has been limited promotion of local foods in area restaurants or other foodservices, this was a unique event that captured community interest. Being in a rural community may have eased some planning obstacles. Most of all, the main element of success was the drive and commitment of the dietitians involved. Everyone thought that others were working harder than themselves (always a good sign!). The main challenges encountered related to the tight planning timelines.<o:p></o:p></span></span></p><p class="MsoNormal"><span class="A3"><span style="font-family:';font-size:10;"><o:p></o:p></span></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A13"><span style="font-size:10;">
<br /></span></span></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><strong><span class="A13"><span style="font-size:10;">Recommendations for future events </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></strong></p><p class="Pa15" style="MARGIN-BOTTOM: 6pt"><span class="A3"><span style="font-size:10;">The following points represent our successes and lessons learned from the planning and implementation processes. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><ul><li><span class="A3"><span style="font-size:10;">Due to the amount of work involved and seasonality of produce, the ideal time to start planning would be at least six months prior to the event. This would support the foresight needed to freeze and preserve summer and fall harvest foods. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Define ‘local’ foods and related parameters, as not everyone involved will have the same context! Decide what proportion of the menu and whether condiments will be ‘local’. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">When choosing a date for the event, ensure that your event is not competing with other high profile events. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Add a sub-committee focused on ticket sales and door management to spread out the workload. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Identify a charitable group (or groups) to receive any proceeds/profits from the event. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Try to tap into the myriad of existing groups and activities that support the evening’s theme and find ways to include them in the process. They are your champions! </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Utilize the various strengths of your planning group. For example, we depended on one creative dietitian with excellent graphic arts skills to finalize signage, the written menu, and vendor/ producer flyer.<o:p></o:p></span></span></li><li><span class="A3"><span style="font-size:10;">Establish clear roles and menu expectations with the chef from the outset of planning. <o:p></o:p></span></span></li><li><span class="A3"><span style="font-size:10;">Promote, promote, promote! Use media – posters, radio spots, newspapers and newsletters, church bulletins, interest group listservs, and local web resources such as town sites and events calendars. We suggest using the Dietitians of Canada press releases as a reference format. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Include schools and youth in various aspects of planning and implementation.</span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Use the opportunity to showcase local successes. Involve the farm community as much as possible</span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Be aware of potential for conflict between the various interests represented by mainstream farmers and industry, and smaller independent farmers (the latter often focus on local, sustainable agriculture and may lean towards organic and/or non-genetically modified production). Strive for a balanced perspective.<o:p></o:p></span></span></li><li><span class="A3"><span style="font-size:10;">Provide clear direction and expectations for those in supportive roles on the evening of the event. <o:p></o:p></span></span></li><li><span class="A3"><span style="font-size:10;">Consider asking attendees to bring an item for the local food bank. <o:p></o:p></span></span></li><li><span class="A3"><span style="font-size:10;">Recognize and reward your volunteers and donors. </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></li><li><span class="A3"><span style="font-size:10;">Have fun!<o:p></o:p></span></span></li></ul><p class="MsoNormal"><span class="A3"><span style="font-family:';font-size:10;"><o:p></o:p></span></span></p><p class="Pa21" style="MARGIN-BOTTOM: 2pt"><span class="A3"><span style="font-size:10;">
<br /></span></span></p><p class="Pa21" style="MARGIN-BOTTOM: 2pt"><span class="A3"><span style="font-size:10;">Further details on the event, including menu, press release, promotion poster, and vendor/producer guidelines can be found at: </span></span><span class="A21"><span style="font-size:10;"><a href="http://www.dietitians.ca/pdf/field2table_spring_supper.pdf">www.dietitians.ca/pdf/field2table_spring_supper.pdf</a> </span></span><span style="font-size:10;color:black;"><o:p></o:p></span></p><p class="Pa23" style="MARGIN-BOTTOM: 5pt"><span class="A3"><span style="font-size:10;">
<br /></span></span></p><p class="Pa23" style="MARGIN-BOTTOM: 5pt"><span class="A3"><span style="font-size:10;">A copy of the committee work plans and vendor/producer promotion flyer are available upon request. For general event planning basics, we recommend ‘Event Planning Suggestions’ (Morley, <i>Practice </i>#17, p. 7, 2002) available at: <a href="http://www.dietitians.ca/members_only/pdf/Issue_17_Practice_Spring2002.pdf">http://www.dietitians.ca/members_only/pdf/Issue_17_Practice_Spring2002.pdf</a></span></span> <p class="MsoNormal"><span class="A3"><span style="font-size:10;"><o:p></o:p></span></span></p><span class="A3"><span style="font-size:10;">
<br /></span></span><p></p><p class="MsoNormal"><span class="A3"><span style="font-size:10;">* </span></span><span class="A1"><span style="font-size:8;">Aimee Cadieux, Candice Comtois, Katharina Froese, Kim Knott, Adrienne Penner, Amanda Nash, Michelle Turnbull, Diane Unruh<o:p></o:p></span></span></p>
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<br /><p class="MsoNormal" style="font-family:verdana;"><span style="font-family:verdana;font-size:130%;"><strong><span style="COLOR: rgb(51,102,102)">Contact
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<br /></p><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Kim Knott RD, CDE
<br /></span></span><p class="MsoNormal" style="font-family:verdana;"><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Winkler MB
<br /><span style="font-size:85%;">E: <a href="mailto:foodmus@mts.net%20">mailto:foodmus@mts.net%20</a></span></span></span></p>
<br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Michelle Turnbull MScCH, RD, CDE
<br /></span></span><p class="MsoNormal" style="font-family:verdana;"><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Morden MB
<br /><span style="font-size:85%;">E: <a href="mailto:michelle.turnbull@mts.net">mailto:michelle.turnbull@mts.net</a></span></span></span></p>
<br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Diane Unruh RD, CDE
<br /></span></span><p class="MsoNormal" style="font-family:verdana;"><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Carman MB
<br /><span style="font-size:85%;">E: <a href="mailto:dmunruh@mts.net">mailto:dmunruh@mts.net</a></span></span></span></p>
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<br /></p></li></ul>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com1063tag:blogger.com,1999:blog-7634030145300729360.post-51113075472291713012010-06-08T15:31:00.011-04:002010-06-14T11:55:31.033-04:00Using Simulation and Video Feedback to Enhance Dietetic Interns’ Counselling Skills and Confidence<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg012xiNfLoBeJ6cretKdvldc6NMTS9yM89azA3g-sv2SPngo7m9bWFyZ6GIxX_Lg0Ec6jVDFqFdQOWykyGpmG0HDXjHYu6aAJJeK3Lgo6V_4W-4U_clrLTUAkQJLGhgFbxr-JPRTNpVKuC/s1600/camcorder.jpg"><img id="BLOGGER_PHOTO_ID_5480490642225373778" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 200px; CURSOR: hand; HEIGHT: 158px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg012xiNfLoBeJ6cretKdvldc6NMTS9yM89azA3g-sv2SPngo7m9bWFyZ6GIxX_Lg0Ec6jVDFqFdQOWykyGpmG0HDXjHYu6aAJJeK3Lgo6V_4W-4U_clrLTUAkQJLGhgFbxr-JPRTNpVKuC/s200/camcorder.jpg" border="0" /></a><br /><br /><p>The transition from dietetic intern to registered dietitian involves a tremendous amount of adaptation over a relatively short time. Interns must acquire the knowledge, practical skills, and critical thinking processes that underpin dietetic practice. In addition, interns must move through a socialization process where they internalize the values, attitudes and behaviours that define how dietitians conduct themselves in the workplace.<br /><br />Evidence suggests that student nurses, medical interns and other trainees (including dietetic interns) experience ’Transition Shock’ (Duchscher, 2008) and struggle with feelings of anxiety, insecurity, inadequacy and instability as they move from the known role of student to the less familiar role of health care practitioner (Kramer, 1974; Duchscher, 2008). Simulations have been identified as a strategy to combat Transition Shock, and can be used to provide a skills-based clinical experience in a safe and secure environment (Fowler-Durham and Alden, 2007). Exposing students to activities that mimic those occurring during practicum training is thought to decrease anxiety and promote skill development.<br /><br /><strong>Role the tape! </strong><br /><br />In September 2008, simulation suites based at the University of Alberta (UA) Health Sciences Education and Research Commons (HSERC) began operations. The suites, constructed to resemble clinical interview or examination rooms, allow students to be discreetly videotaped while engaged in practice-based activities with mock patients. The process used to tape simulated patient care activities at the HSERC is novel. While both the student and the mock patient consent to being videotaped, they have limited awareness of a camera in the room as cameras are disguised as light fixtures and controlled by a teaching assistant from a hidden monitoring room. Video footage of the simulation is saved to a secure website that students can access. Students can only access their own footage. They can do this from home if they wish and can view the footage repeatedly to identify strengths and areas for skill development.<br /><br />The first cohort of dietetic interns participated in simulated patient interviews in the Winter of 2009. The simulations were structured to expand on a basic nutrition assessment and interviewing framework taught in NUTR 466: Introduction to Professional Practice. NUTR 466 is a classroom-based course designed to transition interns into professional life. The interns were asked to interview a mock patient diagnosed with either uncomplicated type 2 diabetes or hyperlipidemia. They were to assess the patient’s nutritional requirements, develop a simple care plan, and provide basic nutrition education. In addition, interns were asked to demonstrate their ability to manage the interview by taking time to develop rapport, set one to three simple goals, and to respond to questions. Intern feedback was extremely positive. They commented that they appreciated being able to ‘see’ how they did while engaged in the interview; many indicated that they had a clearer idea of skills to develop.<br /><br />The simulated interviews are now a dedicated part of the NUTR 466 curriculum. Each intern completes at least two videotaped interviews and additional sessions can be arranged for those who are struggling or who want extra practice. Feedback from interns continues to be positive. Informal feedback from preceptors and interns (once interns are in placements) suggests that simulation use along with the other practical teaching methods used in NUTR 466 have increased intern confidence and readiness to engage in patient interviews.<br /><br /><strong>Cut the tech </strong><br /><br />No simulation suite – no problem! It is possible to reap the benefits of videotaped simulation in ways that are relatively simple to organize:<br /><ul><li>Ask interns to invite a friend, family member or colleague to act as their mock patient. </li><br /><li>Set up a mock interview room by arranging a table and two chairs in front of a clean wall. Place a video camera on a tripod in front of your set.</li><br /><li>Position the intern and the mock patient in the chairs in front of the camera and begin recording. </li><br /><li>After the interview, download the footage and share it by email or save to a disk or data stick.</li></ul><br />All interns experience some degree of “Transition Shock” as they enter the health workforce. However, novel teaching strategies like simulation and video feedback may help to lessen this effect and make the experience enjoyable for both interns and preceptors.<br /><br /><strong>REFERENCES </strong><br /><br />Duchscher JB. (2009). Transition shock: the initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 65(5): 1103-1113.<br /><br />Fowler-Durham C, and Alden KR. (2008). Enhancing patient safety in nursing education through patient simulation. In Patient Safety and Quality: An evidence-based handbook for nurses: Vol. 3. Available at <a href="http://www.ahrq.gov/qual/nurseshdbk/">www.ahrq.gov/qual/nurseshdbk/</a>.<br /><br />Kramer M. (1974), Reality Shock - Why Nurses Leave Nursing. St. Louis: Mosby.<br /><br /><p></p><br /><p class="MsoNormal" style="font-family:verdana;"><span style="font-family:verdana;font-size:130%;"><strong><span style="COLOR: rgb(51,102,102)">Contact<br /></span></strong></span><br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Heidi Bates, MSc, RD<br />Director, University of Alberta Integrated Dietetic Internship<br />Edmonton AB<br /><span style="font-size:85%;">E: <a href="mailto:hbates@ualberta.ca">hbates@ualberta.ca</a></span></span></span></p><br /><br /><p class="MsoNormal" style="FONT-FAMILY: verdana"><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com743tag:blogger.com,1999:blog-7634030145300729360.post-14302215534507331752010-06-04T18:41:00.006-04:002010-06-08T15:25:17.042-04:00The H1N1 Pandemic: A Shot at an Extraordinary Learning OpportunityInterning with Public Health Services in the Capital District Health Authority, Nova Scotia during the H1N1 pandemic was a whirlwind experience. Public Health was my first rotation as an intern. I was privileged to witness both its health promotion and health protection roles during my community rotation. In the late summer, my preceptor alerted me that I would be starting my rotation with Public Health earlier than anticipated in hopes that I would miss an H1N1 pandemic that was forecasted to begin in January. This change did not go as planned as cases of H1N1 arrived earlier than predicted.
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<br /> In the last week of October I could sense that the Public Health team was feeling the heat; it was ‘crunch time’ to prepare for mass immunization clinics as the vaccine had finally arrived. I was fortunate to experience two immunization clinics; once when the vaccine eligibility criteria was restricted to high risk groups and once when the vaccine was available to all. However, I was not involved with clinics every day as I had to complete other competencies unrelated to this unique experience.
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<br />While the nutritionists were at the clinics, I provided day care directors with verbal and written feedback on their menus, integrated dialogue from several meetings into notes, kept a journal, inputted an online survey, and worked on my research project. Because everyone was occupied with H1N1 related activities in the community, I was working in a ‘ghost town’ office complete with empty cubicles and lunches eaten in solitude. This contrasted my earlier experiences when I had had lunch with at least 10 others and would always hear someone typing at their computer. I began to feel a sense of isolation.
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<br />Before my internship, I anticipated that I would receive ample amounts of direction as an intern. My expectations became apparent during the pandemic as my contact with the team was limited. I was nervous that the work I was completing was not sufficient and I had few opportunities to ask for guidance. This unavoidable situation forced me to become more self-directed in my work. I knew I had to finish the projects and that it was time for me to trust my instincts and myself. This was the only way for me to accomplish the projects. Reflecting on this, I realized that I was afraid to believe in myself and that sometimes I have to be bold and take risks, even if it is uncomfortable. I had to trust my capacity and knowledge. I tended to forget that I am in a learning environment where I will make mistakes but will also celebrate successes. I realize that being pushed outside of my comfort zone in this supportive learning environment was integral to preparing me for the future as I continue to encounter experiences with unknown outcomes. <strong>My advice to future interns is to embrace learning opportunities and to engage in these experiences as much as possible - even if you feel thrown into the dangerous ‘deep end of the pool’ instead of what feels to be the ‘safe shallow end’.</strong>
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<br />In December when the immunization clinics came to an end, I was invited to participate in a closing discussion that involved Public Health employees who acted as clinic leaders. This discussion group of about 40 employees amazed me. I realized the honesty and mindfulness that this group of public health professionals possessed. I learned from the many stories told, and was touched and motivated by their enthusiasm and dedication. That evening I participated in a mass immunization clinic and confirmed my perceptions of this working group. I got to see the clinic staff (including volunteers, students, and public health employees) in action.
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<br />My participation in this experience was extraordinary! I believe that fate led me to Public Health during a time when I could experience first-hand health protection and health promotion, two of the core functions of Public Health. I did not learn about the functions of the health care system during times of crisis while at university. Owing to my immersion I feel better prepared for the possibility of involvement in a pandemic in my career.
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<br />I encourage future interns to seek rotation opportunities in public health, and suggest that internship programs provide and promote opportunities encouraging interns to experience community rotations in public health.
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<br />My sincere thanks to the staff members at Capital District Health Authority’s Public Health Services that made this an invaluable learning experience possible. A special thank you to my supportive preceptor, Rita MacAulay.
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<br /><p class="MsoNormal" style="font-family: verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact
<br /></span></strong></span>
<br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Melissa Koch, Dietetic Intern
<br />Capital Health
<br />Halifax, NS
<br /><span style="font-size:85%;">E: <a href="mailto:melissa.koch@cdha.nshealth.ca">melissa.koch@cdha.nshealth.ca</a></span></span></span></p><p class="MsoNormal" style="font-family: verdana;">
<br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;"><strong>Rita MacAulay
<br />Keely Fraser</strong>
<br />Public Health Nutritionists
<br />Capital Health
<br />Halifax, NS</span>
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<br />PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com459tag:blogger.com,1999:blog-7634030145300729360.post-44000974898789812512010-06-04T17:50:00.004-04:002010-06-04T17:52:20.350-04:00Northern Reflections – My Experiences During An Allied Health PlacementIn the summer of 2009, a program offering placements to nursing in northern communities was extended to allied health practitioners at University Health Network. This program, funded by the Ontario Ministry of Health, allowed clinicians to travel north for approximately four weeks to engage in education networking as well as clinical care delivery opportunities. The purpose of this program is to foster collaboration, to exchange knowledge, and to provide an enriched experience among health care practitioners. The opportunity appealed to my adventurous side and on August 24, 2009, I began my northern experience.<br /><br />The bulk of my five-week placement was on Moose Factory Island located on the Moose River just south of James Bay. The island has a population of approximately 2700 individuals who are predominantly of Cree First Nation descent. The nearest town is Moosonee that is so remote that it has no road access. Travel to Moose Factory Island involves a flight or train to Moosonee followed by a boat, helicopter or car ride across the Moose River depending on the season and the stability of the ice road in winter. <br /><br />My placement was based out of Weeneebayko General Hospital – a hospital that had been without an inpatient dietitian for two years. Part of the challenge with this placement was etching out how to best utilize my time and resources while I was there. Some of the responsibilities I undertook included assessing and implementing nutrition care plans with inpatient and outpatient consults, preparing community presentations on a variety of nutrition topics, and assisting in various clinics. I also had the opportunity to fly to the coastal community of Kashechewan to assess the nutritional status of women at the prenatal clinic.<br /><br />The challenges were numerous and overwhelming, and my brain was stretched with the magnitude of nutritional issues that this community faced. Food insecurity, substance abuse, isolation, poverty, and the prevalence of nutritionally relevant illnesses seemed to be more the norm than the exception. In addition to these challenges, there was the education level of the clientele (many could not read English or Cree), the lack of other allied health professionals to which I had become so accustomed (e.g., speech language pathologists), my unfamiliarity with some of the foods (e.g., bannock bread), and the research into nutritional issues that I would not typically see on my general internal medicine unit in Toronto.<br /><br />It was sometimes hard to know what to say to the 20 year old mother of three who told me that she could not afford to eat healthy food when four litres of milk was $13.59 and a five pound bag of potatoes was $10.69. It was difficult to remain unmoved by the elderly gentleman on hemodialysis who was too tired to cook, had no family, and for whom there were neither home care services nor home meal delivery services to provide assistance. There was also the challenge of trying to advise young mothers against feeding their babies evaporated milk and convincing them that it was nutritionally incomplete (even though it was what their mothers had done for them). Food availability did not make it any easier. If you were well accustomed to the grocery store delivery schedule, you could get the pick of the best and freshest groceries available. In-between deliveries, you would be lucky to find half-decent fresh fruits and vegetables, if available at all. One evening when I went to pick up milk, I found that the entire island was sold out until the next delivery.<br /><br />Provision of dietetic services up north is unique in both the needs of the clientele and the retention of professional services. However, despite all of the challenges – maybe even because of them – I found dietitian work in the north to be truly satisfying. Overcoming the seemingly insurmountable hurdles produced a sense of achievement. Dietetics in the north is rewarding and fulfilling; I would encourage you to consider the many opportunities that abound in northern Ontario. I also encourage you to embrace every opportunity you get to immerse yourself in other cultures! Cultural competence is an ongoing process that is developed through familiarization of oneself with and in diverse cultural backgrounds. By better understanding cultural norms and mores, nutrition professionals can tailor nutrition counselling to best meet client needs. For the vast majority of my placement, I was working outside my ‘comfort zone’, and it was a great way to grow, both personally and professionally. I was grateful to be part of such a collaborative initiative that exposes health care staff to unique educational opportunities.<br /><br /><br /><p class="MsoNormal" style="font-family: verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Tiffany Krahn, RD<br />University Health Network<br />Toronto Western Hospital<br />Toronto, ON<br /><span style="font-size:85%;">E: <a href="mailto:tiffany.krahn@uhn.on.ca">tiffany.krahn@uhn.on.ca</a></span></span></span></p><p class="MsoNormal" style="font-family: verdana;"><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com378tag:blogger.com,1999:blog-7634030145300729360.post-32875965820335652952010-05-05T12:57:00.008-04:002010-05-05T13:04:57.743-04:00Necrotizing Enterocolitis and the Preterm Infant<div>Necrotizing Enterocolitis (NEC) is an inflammatory bowel disease affecting three to ten percent of neonates in intensive care units (ICU) (Bisquera et al., 2002: Guthrie et al., 2003) and results in necrosis of the intestinal tissue and possible perforation of the bowel (Kafetzis et al., 2003; MedlinePlus, 2009). NEC predominantly affects low birth weight (LBW) and very low birth weight (VLBW) neonates (Kafetzis et al., 2003; Martin et al., 2008) and plays a significant role in the morbidity and mortality (rates reported between 13%-25%) of these infants (Guner et al., 2009; Henry et al., 2009; Lambert et al., 2007). A Canadian survey of 18,234 infants, in 17 neonatal intensive care units (NICU), reported the incidence of NEC among VLBW infants ( less than 1500g ) as 6.6 percent (Sankaran et al., 2004).<br /><br />The etiology of NEC (with severity classified on a scale of I (mild) to III (severe, including GI hemorrhage and septic shock) (Bell et al., 1978)) is multifactorial. Many pathogenic factors play a role, including, immaturity and ischemia of the gastrointestinal (GI) tract, and changes in commensal gut microflora (normal, indigenous bacteria) accompanied by increases in pathogenic bacteria as well intestinal inflammation (Hsueh et al., 2003; Panigrahi, 2006; Thompson et al., 2008). Treatment includes medically and surgically invasive procedures such as intravenous fluids, orogastric and peritoneal drainage and laparotomy (Panigrahi, 2006; Thompson et al., 2008). It is therefore important to prevent and manage the disease so that this already vulnerable population is not placed under even greater risk for complications.<br /><br /><strong>Are There Alternative Treatments?<br /></strong><br />Reviews of the use of probiotics (defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (FAO/WHO, 2001, pg. 5)) for the treatment of acute and antibiotic associated diarrhea and atopic dermatitis in infants have suggested that for these conditions, probiotics are tolerated well, and are beneficial and safe for infants (Kullen et al., 2005; Saavedra, 2007).<br /><br />Although not as extensive, research regarding administration of prophylactic probiotics to VLBW neonates shows a decrease in the incidence a nd severity of NEC. The rationale for supplementation of probiotics for prevention and management of NEC in infants is that the bacteria will restore microbial balance to the immature gut by competing with pathogens, thereby improving the gut barrier and decreasing inflammatory responses (Costalos et al., 2003; Cucchiara et al., 2002; Martin et al., 2008).<br /><br /><strong>Relevance to Practice<br /></strong><br />Clinical trials conducted in NICUs using various probiotics are promising. Dani et al. (2002) conducted a prospective, multi-centre, double-blind, randomized study of VLBW preterm infants. The probiotic group (PG) received a dose of 6 x 109 colony-forming units (CFU) of <em>Lactobacillus</em> GG each day (in pasteurized breastmilk or infant formula) until discharge. The incidence of NEC was lower in the PG (1.4 compared to 2.8 percent) but not significant. Bin-Nun et al. (2005) conducted a blinded randomized trial using a different probiotic supplement (ABC Dophilus: <em>Bifidobacteria infantis</em>, <em>Streptococcus thermophilus</em> and <em>Bifidobacteria bifidus</em> at a dose of 1.05 x 109 CFU per day added to breastmilk or enteral formula). Incidence of NEC in the PG was significantly lower (4 percent) than the placebo group (16.4 percent; p=0.03), as was the severity. Two randomized controlled trials, using Infloran (<em>Lactobacillus acidophilus</em> and <em>Bifidobacterium infantis</em>; dosage of 125 mg/kg per dose of 109 CFU twice daily added to breastmilk or formula) on VLBW infants, demonstrated a significantly lower incidence and severity of NEC in the PG (Lin et al., 2005; Lin et al., 2008). Lastly, a historic control group was compared to a newborn PG (treated with <em>Lactobacillus acidophilus</em> and <em>Bifidobacterium infantis</em>, 250 x 106 CFU, in sterilized water or 5 percent dextrose, via orogastric tube or drops into the mouth) admitted to the ICU during one year. Although the dose was smaller than other studies, this trial demonstrated a significant reduction in NEC (Hoyos, 1999). No significant adverse reactions were reported in these studies.<br /><br />Probiotics are potentially beneficial in preventing NEC in neonates. However, evidence is lacking to recommend the most beneficial probiotics, the best time to initiate prophylaxis, the optimal dose, or the duration of treatment. A predictive model using United States NEC statistics estimated an increase length of stay (where surgical NEC infants exceeded controls by 60 days and medical NEC infants exceeded controls by 22 days), and an additional $6.5 million in hospital charges per year, or $216,666 per NEC survivor (Bisquera et al., 2002). As technology and health care practices improve, survival of VLBW neonates will increase possibly increasing the incidence of NEC. This should be taken as a call to action. The ‘cost’ of NEC on the neonatal community (financially for the health care system, and emotionally for parents aware of the bleak statistics) is arguably far greater than the ‘price’ of using health care dollars to research best practices for the use of probiotics for the prevention of NEC in neonates.<br /><br />REFERENCES available from Andrea Buchholz. </div><br /><br /><p class="MsoNormal" style="font-family: verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Deborah Van Dyke<br />4th year student (visiting from U of A)<span style="font-size:85%;"><br />E: <a href="mailto:dvandyke@uoguelph.ca">dvandyke@uoguelph.ca</a></span></span></span> <br /><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Andrea Buchholz, PhD, RD<br />Faculty Advisor<br />Dept of Family Relations and Applied Nutrition<br />University of Guelph<span style="font-size:85%;"><br />E: <a href="mailto:abuchhol@uoguelph.ca">abuchhol@uoguelph.ca</a></span></span></span></p><p class="MsoNormal" style="font-family: verdana;"><br /><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com883tag:blogger.com,1999:blog-7634030145300729360.post-83965387528347549972010-04-20T11:06:00.006-04:002010-04-20T11:14:32.509-04:00Vitamin K in Bone Health<span style="font-weight: bold;">Phylloquinone (vitamin K1) is in foods of plant origin, especially leafy greens and soybean, canola, and olive oil. Menaquinone (vitamin K2) includes multiple forms found in cow’s liver, some meats, and products of bacterial fermentation such as cheese, natto, and miso.</span> Little is known about the contribution of menaquinones to vitamin K status and while initially thought that 50 percent of the daily requirement for vitamin K was provided by intestinal flora, there is insufficient evidence to support this (Booth, 2003).<br /><br />The different vitamin K entities have tissue-specific distribution. Liver, the main storage site, contains longchain menaquinones (MK-7 through MK-13) and a minor amount of phylloquinone. In plasma and bone, the major forms are phylloquinone followed by short-chain menaquinones MK-4 through MK-8.<br /><br />The only known biochemical role for vitamin K is as a cofactor in carboxylation of specific glutamate residues in certain proteins. Finding vitamin K-dependent proteins in the skeleton lead to the hypothesis that vitamin K has a role in bone (Booth, 2003). Furthermore, α–carboxyglutamyl residues in these proteins provide mineral binding properties. There are at least three vitamin K-dependent proteins in bone and cartilage; osteocalcin, matrix gla protein, and protein S. Osteocalcin, the best understood of the three, is synthesized by osteoblasts during bone matrix formation. Its hydroxyapatite-binding capacity is associated with α-carboxylation of glutamate residues 17, 21 and 24; carboxylation of residue 17 is required for the conformation that allows binding of osteocalcin to hydroxyapatite.<br /><br />Percent undercarboxylated Osteocalcin (ucOC) is a marker of vitamin K status. However, an inverse relation exists between serum 25(OH)vitamin D and ucOC. Thus, controlling vitamin D status is important when assessing the impact of vitamin K on bone health (Booth, 2003). Until recently, supporting evidence of a role for vitamin K in age-related bone loss was largely based on associations between dietary intakes or biological markers of vitamin K status and bone mineral density (BMD) or hip fracture. Randomized controlled trials (RCT) attempt to determine whether vitamin K1 has a role in the prevention or treatment of osteoporosis.<br /><br />This article summarizes four key RCTs of vitamin K1 with dose ranging from 200 ug to 5000 ug per day (1-4). Three trials studied postmenopausal women while the fourth studied older women and men; these studies controlled vitamin D and calcium intakes (previous Vitamin K1 trials have not always done so). Furthermore, subjects started with comparable vitamin K status in all studies and vitamin D status in three of the studies. All studies followed BMD; unfortunately only one also monitored fracture incidence.<br /><br />Giving vitamin K1 at 200 ug and 5000 ug per day appeared to have a positive effect on bone (1,2). Subjects treated with 200 ug showed a continuous significant increase in BMD over 6 months at the ultradistal radius. Fracture incidence was lower with a 5000 ug vitamin K1 treatment despite no effect on bone density. Vitamin K’s effect may have been on bone microarchitecture. However, since very few subjects had fractures, the observed difference in fracture rate may have occurred by chance. In a third study (3) where vitamin D status was not assessed, 1000 ug of vitamin K1 had no effect on BMD. Finally in a fourth study (4), 500 ug vitamin K1 had no effect on BMD. Larger trials including a range of K1 doses. with fracture as an endpoint and side effect monitoring, are needed.<br /><br /><span style="font-weight: bold;">Implications for Counselling Patients:</span><br /><br />In my work at the Osteoporosis Program I am seeing an increasing number of patients taking calcium supplements including vitamin K with marketers stressing its importance in bone health. The typical dose of 50 ug/tablet is so paltry that I feel obliged to explain that a serving of leafy green vegetables provides 200 – 300 ug vitamin K along with many other nutrients and health benefits. I clarify how little their supplements provide in relation to the levels being tested in RCTs.<br /><br />I also see patients taking anticoagulants who have the misconception that they should avoid all leafy greens because their vitamin K content will interfere with anticoagulation. I recommend to them the need for reasonable consistency in intake of leafy greens from day<br />to day rather than avoidance.<br /><br /><span style="font-weight: bold;">REFERENCES</span><br /><br />Binkley N, Harke J, Krueger D, Engelke J, Vallarta-Ast N, Gemar D, Checovich M, Chappell R, Suttie J. (2009). Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density or geometry in healthy postmenopausal North American women. Journal of Bone and Mineral Research. 24:983-991.<br /><br />Bolton-Smith C, McMurdo M, Paterson C,Mole P, Harvey J, Fenton S, Prynne C, Mishra G, Shearer M. (2007). Two-year randomized controlled trial of vitamin K1(phylloquinone) and vitamin D3 plus calcium on the bone health of older women. Journal of Bone and Mineral Research. 4: 509-19.<br /><br />Booth S L. (2003). Dietary vitamin K and skeletal health. In: Nutritional aspects of bone health., The Royal Society of Chemistry: Cambridge, UK.<br /><br />Booth SL, Dallal G, Shea MK, Gundberg C, Peterson JW, Dawson- Hughes B. (2008). Effect of vtamin K supplementation on bone loss in elderly men and women. Journal of Clinical Endocrinology and Metabolism. 93: 1217-1233.<br /><br />Cheung A, Tile L, Lee Y, Tomlinson G, Hawker G, Scher J, Hu H, Vieth R, Thompson L, Jamal S, Josse R. (2008). Vitamin K supplementation in postmenopausal women with osteopenia (ECKO Trial): A randomized controlled trial. Public Library of Science Medicine. 5(10): 1461-1471.<br /><br /><p class="MsoNormal" style="font-family: verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Debbie Reid, MSc, RD<br />BC Women's Hospital and Health Centre<br />Vancouver, BC<br /><span style="font-size:85%;">E: <a href="mailto:dreid@cw.bc.ca">dreid@cw.bc.ca</a></span></span></span></p><p class="MsoNormal" style="font-family: verdana;"><br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com442tag:blogger.com,1999:blog-7634030145300729360.post-15953535125028993262010-04-07T14:12:00.006-04:002010-04-07T14:42:16.548-04:00From Meal Trays to Dining Room…<img src="file:///C:/DOCUME%7E1/suzanne/LOCALS%7E1/Temp/moz-screenshot.png" alt="" /><meta name="ProgId" content="Word.Document"><meta name="Generator" 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mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style> <![endif]--> <p class="MsoNormal" style=""><b><span style=";font-family:";font-size:10pt;color:black;" ><o:p> </o:p></span></b></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >Sunnybrook Health Sciences Centre houses Canada’s largest veteran population, providing long term and complex continuing care to approximately 500 elderly veterans. In June of 2007, six Nursing Home units, representing 204 beds in the Veterans Centre, were converted from tray meal service to a bulk meal service dining room to align with the Ontario Ministry of Health and Long Term Care Dietary standards. The project presented a unique opportunity, not only because of the size of the population involved, but because most other long term care facilities offering bulk meal service have done so from the time of opening and rarely undergo a change in service model.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >As dietitians working in food services our priorities are meeting nutrition standards, menu planning, meeting fiscal responsibilities, and patient/resident satisfaction. To evaluate that we met our objectives fo r this project, we retrospectively collected data pre – and post-implementation looking at nutritional parameters (e .g., weight, nutritional risk level , diet), financials, and food satisfaction. Converting to a bulk meal service did not appear to impact the residents’ nutritional status parameters, we were able to operate within our financial objectives, and our third party food satisfaction survey showed that changing the meal service model had no sustained impact on residents’ satisfaction with food. Despite achieving our food service objectives, the food serv ice team spent the majority of time addressing the unforeseen social outcomes of this change.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >Adjusting to anything new takes time. The bulk meal service model had many benefits for residents, however, asking anyone to change their daily routine, especially around meals, inevitably results in some resistance. The new daily social interaction among residents at meal times allowed many relationships to flourish but also opened the door for conflict <span style=""> </span>among others. Who sits with whom in the dining room was not an easy puzzle to put together. Waiting for tables to be served exposed residents to wait times that were previously less obvious when they ate in their rooms. Dietary restrictions were more visible to tablemates, and suddenly, residents started asking for specific food items of which they had not previously been aware. This phenomenon stimulated discussion among the care team about liberalizing the resident menu.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >Despite the fact that forecasting, preparation, and production were done separately for each seating, having a ‘second seating’ at meals gave some residents the perception that ‘first seating’ received preferential treatment, and that those seated second were getting leftovers. Education with staff, residents and family members was necessary to dispel this myth.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" > <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >The bulk meal service was implemented in phases bringing on one nursing unit per week over four weeks so that we could focus on the particular needs of each unit. Unique challenges surfaced when the implementation took place on the Cognitive Unit. Continuity is important for these residents; they may not be able to recall yesterday’s events but adapt well to routines. One resident, when offered a choice of two entrées replied, “I don’t want either, I just want my lunch tray”. Where family members previously made menu selections for residents with the tray service, some residents appeared overwhelmed having to shift to making seemingly simple food choices three times a day. Over time, the bulk meal service became routine and these challenges now seem to be non-issues. All of our experiences during the implementation prompted good discussion between our department and the care team about dining room philosophy and creating a home-like environment.<span style=""> </span>Dining ‘ground rules’ for processes and conduct for both staff and residents continues to be a work in progress to improve the quality of the dining room experience.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >Resident satisfaction with the bulk meal service was of high importance for both our department and for the organization in evaluating the success of the project. Despite the fact that there does not appear to be a difference in resident satisfaction over the long term, it is important to note that the satisfaction survey primarily assessed operations and food services para meters (e.g., quality, timeliness, temperature ). The potential impact of a dining environment and mealtimes on other factors related to quality of life cannot be discounted.</span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style=";font-size:100%;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:100%;"><b style=""><span style="color:black;">Lessons learned from this project:</span></b></span></p><p class="MsoNormal" style="font-family:verdana;">
<br /><span style="font-size:100%;"><b style=""><span style="color:black;"><o:p></o:p></span></b></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >1. Get to know the population and consider the social impact of the change for the residents and families;<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >2. Consider a broader survey tool to evaluate the impact of changing the meal service model on residents’ quality of life; <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >3. Recognize the value of ongoing communication with the residents and families; and,<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style=";font-size:100%;color:black;" >4. Be patient!</span></p><p class="MsoNormal" face="verdana">
<br /></p><p class="MsoNormal" face="verdana">
<br /></p><p class="MsoNormal" style="font-family: verdana;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact
<br /></span></strong></span>
<br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Alexa Edmonstone, RD
<br />Clinical Dietitian
<br /><span style="font-size:85%;">E: <a href="mailto:alexa.edmonstone@sunnybrook.ca">alexa.edmonstone@sunnybrook.ca</a></span></span></span></p><p class="MsoNormal" style="font-family: verdana;">
<br /></p><p class="MsoNormal" style="font-family: verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Ann Robertson, RD
<br />Director, Food Services</span></span></p><p class="MsoNormal" style="font-family: verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Sunnybrook Healthcare Food Services
<br /></span></span></p><span style="color: rgb(51, 102, 102); font-family: verdana;font-size:85%;" ><span style="font-weight: bold;">E: <a href="mailto:ann.robertson@sunnybrook.ca">ann.robertson@sunnybrook.ca</a></span></span><p class="MsoNormal" face="verdana">
<br /></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com440tag:blogger.com,1999:blog-7634030145300729360.post-55875746299001673232010-03-23T14:11:00.013-04:002010-03-23T14:25:44.997-04:00Dietitians at the Forefront of Primary Care Reform<p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style="">There are currently 2.5 million Canadians with diabetes </span></b></span><span style="font-size:100%;">(CIHR, 2009). Currently only one-third of people with diabetes have preventive tests (e.g., foot or eye checks) done (CIHR, 2009). Fifty percent of the complications of diabetes can be prevented. In 2010, diabetes will cost $12.2 billion (CDA,2009). Diabetes is responsible for almost 10% of the total direct costs of the Ontario health care system (CDA,2009).</span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><br /></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;">A gap exists between what we know and what we practice. The mission of the Hamilton Family Health Team (HFHT) Diabetes Learning Collaboratives is to close this gap. HFTF diabetes teams are made up of physicians, nurses or nurse practitioners, administrators and dietitians; some teams also have pharmacists. The majority of the team dietitians hold the Certified Diabetes Educators (CDE) credential and play an active role in the care of patients living with diabetes. We chose to implement practice improvements primarily through Learning Collaboratives.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><br /></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;">Two Learning Collaboratives, each involving a number of HFHT practices, were launched in mid-2008. These focused around several face-to-face learning sessions. In-between structured learning sessions are ‘action periods’ during which teams use the Model for Improvement (Wagner, 1989) and the Care Model (Wagner, 1998) to redesign and improve the care delivery systems within their practices. The Model for Improvement is a strategy for testing, implementing, and spreading practice innovations. It includes use of plando- study-act (PDSA) cycles or rapid cycle improvement. The Care Model is a framework for an ideal system of healthcare for chronic conditions that can be used to identify areas for improvement.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><br /></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;">Throughout the Learning Collaboratives, teams interacted with each other and with change facilitators, and by sharing reports. During action periods, a listserv was helpful for sharing tools and lessons learned, obtaining answers to questions, generating ideas for removing barriers, and identifying resources. Teams were expected to use data to monitor their improvement efforts. Every six months, team and aggregate clinical progress was assessed.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><o:p> </o:p></span></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><br /></span></b></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style="">Results: <span style=""> </span></span></b></span><span style="font-size:100%;">Over a year there was an approximate ten percent improvement in number of <span style=""> </span>patients with HbA1c, LDL, blood pressure and microalbumin tests completed, number of patients using an ACE or an ARB (blood pressure medications), and in patients having an LDL less than 2.0 mmol/L. We did not see significant clinical improvements in HbA1c results because we were bringing in patients who had not been seen recently and who had higher HbA1c results. This overshadowed improvements in other patients.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><o:p> </o:p></span></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><br /></span></b></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style="">Learning: <span style=""> </span></span></b></span><span style="font-size:100%;">RDs were an integral part of each learning team. Because the individual RDs with the Hamilton Family Health Team often participate on many different physician teams, they were instrumental in sharing change strategies. For example, one RD was able to share how one of her teams had sent a letter to all their patients with diabetes, asking them to get bloodwork done only at laboratories that could share results electronically. This resulted in more visits being productive because the practice had already seen patients’ bloodwork. Many teams used this opportunity to address access to care for physicians and other providers (e.g., RDs, pharmacists).<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><o:p> </o:p></span></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><br /></span></b></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style="">Conclusions: <span style=""> </span></span></b></span><span style="font-size:100%;">Learning Collaboratives are an effective way to improve care. This process highlighted the role of the RD as information gatherer and sharer, change agent, and project coordinator leading to deeper trust and respect for the RDs on these teams and to greater job satisfaction for participating RDs.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><br /></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;">For further information about Learning Collaboratives see <a href="http://www.improvingchroniccare.org/" target="new">www.improvingchroniccare.org</a>.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style=""><br /></span></b></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><b><span style="">RESOURCES</span></b></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><br /><span style="font-size:100%;"><b><span style=""><o:p></o:p></span></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;">Canadian Institute for Health Information. (2009). Diabetes Care Gaps and Disparities in Canada. 2009. Available at: <a href="http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2551_E&cw_topic=2551&cw_rel=AR_3191_E" target="new">http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2551_E&cw_topic=2551&cw_rel=AR_3191_E</a><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;font-family:verdana;"><span style="font-size:100%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;"><span style=";font-family:";font-size:10pt;" ><span style="font-size:100%;"><span style="font-family:verdana;"><br /></span></span></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: normal;"><span style=";font-family:";font-size:10pt;" ><span style="font-size:100%;"><span style="font-family:verdana;">Canadian Diabetes Association. (2009). An economic sunami: The cost of diabetes care in Canada. Available at: Accessed at: </span><a style="font-family: verdana;" href="http://media3.marketwire.com/docs/cda207report.pdf" target="new">http://media3.marketwire.com/docs/cda207report.pdf</a></span><span style=";font-family:verdana;font-size:100%;" > </span><span style="font-size:100%;"><span style="font-family:verdana;">Wagner EH. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1: 2-4.</span></span><o:p></o:p></span></p> <p class="MsoNormal"><span style="line-height: 115%;font-family:";font-size:10pt;" ><o:p><br /><span style=";font-family:verdana;font-size:100%;" ><strong><span style="color: rgb(51, 102, 102);">CONTACT<br /></span></strong></span><span style="font-size:100%;"><br /></span><span style="color: rgb(51, 102, 102);font-family:verdana;font-size:100%;" ><span style="font-weight: bold;">Tracy Hussey, MSc, RD<br />Nutrition Program Manager<br />Hamilton Family Health Team<br />Hamilton, ON<br />T: (905) 667-4857<br /></span></span><br /></o:p></span></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com459tag:blogger.com,1999:blog-7634030145300729360.post-36749384039077075722010-03-09T14:34:00.007-05:002010-03-09T14:47:13.122-05:00What Does it Take to be Successful in Our Work?<p>I have asked myself this question many times and the answer is not as clear or as straightforward as I would like it to be. Over time, what did become clear to me was that I was getting burnt out. How could I be good at what I did if I did not feel good about it?<br /><br />According to Gallup Organizational Research, the characteristics of my “burnout” self is defined as “unengaged”. In a typical organization, 55% of staff members are unengaged, they demonstrate lower commitment, less connection with co-workers, more focus on activities instead of outcomes, and high stress. Engaged staff show support for each other and find more effective ways to accomplish their roles. Looking back, orientation is the ideal time to gain and maintain engagement in new staff.<br /><br />I was aware that over the years there was little community nutritionist turnover and so there was no push to have formal development or evaluation of orientation. The role is equivalent to working as a sole-charge dietitian at the health unit without a practice leader providing leadership and support. As part of a Frontline Leadership course, I decided to survey my colleagues on their thoughts about their orientations and their perceptions of success at their work. Ten out of eleven nutritionists working with the adult population responded to a 10-item online survey.<br /><br />The survey findings revealed the following perceptions about orientation:<br /><br /><ul><br /><li>50% were not satisfied with the amount of orientation time</li><br /><br /><li>70% felt that orientation did not prepare them to do their job</li><br /><br /><li>50% felt they did not have clear expectations of their role</li><br /><br /><li>70% felt they did not know what their coworkers expected of them</li><br /><br /><li>50% felt that they knew what best resources or contacts to use when there were questions</li><br /><br /><li>during their first three months of work, 50% had weekly questions and 30% had daily questions re: their work/role</li><br /><br /><li>90% felt having a mentor during the first year of work would have been helpful. </li></ul><br /><p>Respondents reported needing from one to five years to adjust to and to feel confident in doing their work. They had no concerns with the nutrition-related content aspects of their work; contextual considerations such as learning about the organizational structure, procedures and how the position related to other organizations and initiatives took longer to learn.<br /><br /><strong>Lessons Learned</strong> </p><p>An orientation subcommittee was struck and suggested the following: </p><ul><br /><li>Establish consistent content and implementation of orientation.</li><br /><br /><li>Establish processes for providing initial and ongoing support.</li><br /><ul><br /><li>Identify key contact person/coach.</li><br /><br /><li>Be able to check in regularly with the key contact person; have more opportunities to be together at the same site.</li><br /><br /><li>Develop a community of practice of dietitians (identify who can provide what kind of support and when).</li></ul><br /><li>Develop a list of competencies to provide the basis for development of individual learning plans.</li></ul><br />We created a list of competencies specific to our work by combining examples from the Public Health Nutrition Framework and the College of Dietitians of BC Standards of Practice. Each competency outlines suggested activities to help enhance each skill area that a new hire can use to develop personal learning plans.<br /><br />The project has uncovered areas around orientation never before addressed, in particular skill development and job satisfaction. After sharing the results with other community nutritionists working with other populations or programs, many identified similar experiences with their orientations. This led me to wonder how other community nutritionists without practice leaders address orientation and what kind of, if any, ongoing support they receive and/or provide.<br /><br />Being successful in your work relates to being engaged. In turn, role clarity, clear performance expectations, positive environments, appreciative healthy relationships, and work enjoyment all influence engagement. These factors all impact client engagement, staff/peer relationships<br />and workplace business. Although the program managers (non-dietitians in our case) are responsible for providing information about what is required to succeed, orientation to facilitate success in the position, and coaching (including identifying strengths, areas for development and actions required), in reality they cannot. As community nutritionists, we need to take on these responsibilities to support each other and to do so on an ongoing basis. One way is to create a community of practice that fosters an environment of relationship building, and sharing of learning and innovation from like-minded colleagues who share common interests, challenges and expertise. Engaging in a community of practice can help those working solo to increase their understanding of their practice, and to develop strategies and knowledge more quickly and effectively.<br /><br />Since completing this project, I have started a new position. Knowing what is needed to transition to a new job helped me direct my own orientation that included exploring communities of practice. I encourage new hires, particularly those in sole-charge positions, to advocate and implement the above strategies if they are not already in place. For me, having the awareness and the tools to maintain engagement is a small success.<br /><br /><strong>REFERENCES</strong><br />Endsley S, Kirkegaard M, Linares A. (2005). Working together: Communities of practice in family medicine. Family Practice Management. Available at: www.aafp.org/fpm/2005/0100/p28.html<br /><br /><span style="font-family:verdana;font-size:130%;"><strong><span style="COLOR: rgb(51,102,102)">Contact<br /></span></strong></span><br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Vanessa Lam, RD<br />Vancouver Coastal Health<br />T: (604) 321-7051 (3331)<br />E: <a href="mailto:vanessa.lam@vch.ca">mailto:vanessa.lam@vch.ca</a><br /></span></span><br /><br /><p></p><br /><p></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com273tag:blogger.com,1999:blog-7634030145300729360.post-44353551131808989852010-02-23T12:09:00.004-05:002010-03-02T10:46:05.790-05:00Co-Creating a History of Dietetics in Canada<span style="font-weight: bold;">From David:</span><br /><br />One of the most exciting times for me as an undergraduate was discovering that books (whole books!) about the history of our profession in Canada had been written. In order of publication, these are: <span style="font-style: italic;">The Dietetic Profession in Canada</span> (Margaret Lang and Elizabeth Upton, Eds., 1973), and <span style="font-style: italic;">Canadian Dietitians: Making a Difference</span> (Eleanor Brownridge and Elizabeth Upton, Eds., 1993). Reading these books were important moments for me because they connected me to the enduring stories of the profession that I was joining – how it had grown, the struggles and adversities it had overcome, and how it had strategized for the future. As I finished reading <span style="font-style: italic;">Canadian Dietitians: Making a Difference</span> I thought about the internal and external changes that have affected dietetics over the last 20 years. These include changes in government funding of healthcare in the 1990s and 2000s, the change from the Canadian Dietetic Association to Dietitians of Canada, the creation and growth of the Canadian Foundation for Dietetic Research, and the development of the Vision 2020 plan. I wondered how an updated resource could be made of the history of dietetics in Canada that would encompass and inform about these times.<br /><br /><span style="font-weight: bold;">From Cathy:</span><br /><br />I met David at the <span style="font-style: italic;">Beyond Nutritionism</span> Workshop at Ryerson University in June 2009. We discovered our shared interest in the history of dietetics and had a few quick conversations about how one could go about composing such a history. After I returned home, I thought that it would be a fascinating and lifelong project to co-create a history, not just with David, but by inviting others who were interested to contribute. I shared this idea with David, he loved it, and the result is this invitation to join us in a history project. My interests in the history of dietetics are twofold; what practitioners actually did, and how social, political and technologic developments influenced practice; and the evolution of dietetics education. These areas of research differ from, but are complementary to, the focus of existing publications about dietetic history in Canada (those David mentioned and Roseann Nasser’s article on the Saskatchewan Dietetic Association in issue 46 of <span style="font-style: italic;">Practice</span>) that focus on the creation and accomplishments of dietetic associations. Years ago, I invited readers of <span style="font-style: italic;">Practice</span> to send me any documents, books or resources they were planning to throw out so that I could begin to compile an archive of materials to support history projects. To this day boxes and packages of these cast offs arrive at my house that frequently contain treasures. There is now a nice collection of diet manuals from different parts of the country, as well as records of local, provincial, and national initiatives. These are the sorts of things that can be digitized for widespread access in support of historical research.<br /><br /><hr><br /><br />A constantly updated history of dietetics in Canada would inform and connect students and practitioners to the course that their profession has charted to the present day, and it would provide a new vehicle for the public and researchers from other disciplines to discover more about the history, spirit, and specialized skills of dietitians. We imagine presenting information in different formats such as a website, book or book series, and/or film(s), whatever media would best achieve the goal of connecting people with the emerging history.<br /><br /><span style="font-weight: bold;">We are interested in connecting with any dietitians, currently practicing or retired, from all decades of practice who have an interest in contributing materials or thoughts about the history project, or who have written history papers for course work, presentations to colleagues, or for personal interest.</span><br /><br />Other possible contributions to the history include accounts of areas of specialization or super-specialization, resources or tools formerly used in practice, government documents that influenced practice or policy, recollections of practitioners or educators, and narratives of the evolution of practice. Please be in touch with either of us if you are interested in participating in helping to document our story.<br /><br /><br /><br /><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">David Smith, BASc. - Dietetic Intern<br />The Ottawa Hospital Dietetic Internship Program<br />T: (819) 777-0815<br />E: <a href="mailto:djmsmith@gmail.com">djmsmith@gmail.com</a><br /></span></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Catherine Morley, PhD, RD, FDC<br />West Vancouver, BC<br />T: (604) 925-1209<br />E: <a href="mailto:catherine.morley@gmail.com">catherine.morley@gmail.com</a><br /></span></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com332tag:blogger.com,1999:blog-7634030145300729360.post-67748433577381039442010-02-19T17:07:00.010-05:002010-02-23T11:48:30.455-05:00Self-Running PowerPoint Presentations – Part 2This article continues from Part 1 (last issue), a description of how to create and share selfrunning PowerPoint<sup>TM</sup> presentations (SRPP), and outlines how to convert presentations to video.<br /><br />Conversion (the easiest way to share them on the Internet) is challenging and requires patience (or a friend with computer/video knowledge).<br /><br /><strong>Converting the SRPP to Video and Uploading tothe Internet:<br /></strong>Several computer programs can convert a SRPP into a video file. PPT 2 Video<sup>TM</sup> ($50 from <a href="http://www.acoolsoft.com/" target="new">http://www.acoolsoft.com/</a>) is designed for this purpose and works well. Fast computer processing is necessary. Download the 30-day free trial to make sure it works on your computer. Another option is to use a screen capture program. As the SRPP plays on your computer, the program converts the visuals and audio into a video file. Camtasia<sup>TM</sup> ($300 from <a href="http://www.techsmith.com/camtasia.asp" target="new">www.techsmith.com/camtasia.asp</a>) is more expensive, but the program is quicker and more versatile (e.g., you can do a lot more than capture PowerPoint<sup>TM</sup> presentations). A 15-minute presentation takes 15 minutes to record with a screen capture program; the same presentation would take about 2 hours with PPT 2 Video<sup>TM</sup>. One of the challenges is deciding what codex to convert to (a topic beyond the scope of this article) and the resolution (i.e., the number of pixels in the width and height). High definition (1280 x 720 pixels) creates a sharper image but is difficult for anyone with a slow Internet connection to view.<br /><br />There are several websites to which you can upload videos without charge (e.g., YouTube<sup>TM</sup> and blip.TV<sup>TM</sup>). These are great choices if you want to reach a large audience as people search these websites. Many companies also offer video hosting services but the fees can be high. The videos can also be embedded into a website.<br /><br /><strong>Video Editing Software for Creativity:</strong><br />The SRPP video can be edited with a video editing software program. This works well for combining the SRPP with another video, and works better than trying to insert a video into a PowerPoint<sup>TM</sup> presentation. The other video could be something recorded with a video camera or captured from a computer screen. For example, I incorporated videos demonstrating product use into an SRPP about specialty food products. My favourite video editing software program is Vegas Movie Studio 9<sup>TM</sup> ($90 US from <a href="http://www.sonycreativesoftware.com/" target="new">http://www.sonycreativesoftware.com/</a>).<br /><br />Converting an SRPP to video, editing, and uploading to the Internet is not a simple task. However, the effort and patience to develop the knowledge and skills to make this happen can by worthwhile. In addition to the professional possibilities, creating personal home videos is a fun and fulfilling hobby.<br /><br /><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Wendy Busse, RD, MSc<br />Red Deer, AB<br />T: (403) 986-5267<br />E: <a href="mailto:wendybusse@foodallergynews.com">wendybusse@foodallergynews.com</a><br /></span></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com391tag:blogger.com,1999:blog-7634030145300729360.post-70353714991257645182010-02-16T15:13:00.004-05:002010-02-16T15:19:22.884-05:00Chinese Delegates’ Visit to TorontoFrom July 27 to 29, 2009, a group of senior physician delegates from China attended a special three-day visit to Toronto and Ottawa hosted by the Canadian Diabetes Association. We, the Diabetes Education care team, were honoured to be able to participate in hosting the Chinese delegates’ visit to our Diabetes Education Centre DEC) at the Toronto General Hospital (TGH).<br /><br />The Canadian Diabetes Association (CDA) indicated that an objective of the Chinese delegates’ visit was for the DEC to share and exchange knowledge in the area of diabetes education services including nutrition therapy and lifestyle management perspectives in diabetes management. Diabetes is a growing health concern in China. According to data from the International Diabetes Federation’s 2007 Diabetes World Atlas, 40 million Mainland Chinese are living with diabetes leading to many challenges for Chinese healthcare professionals. The high population of Chinese with Type 2 diabetes may well be linked to China’s growing and prospering economy leading to major dietary and lifestyle changes.<br /><br />It was our great desire to have an open line of communication between the Chinese delegates and Canadian healthcare professionals. With limited knowledge of the Chinese health care system, clinic and hospital environments, and the distinct provincial backgrounds of the Chinese delegates, the diabetes care team found this visit extremely interesting and insightful.<br /><br />On the second day of the visit, the 13 delegates arrived at the TGH DEC. They were warmly welcomed by Dr. Rene Wong, Director of Diabetes Care and Education; Marianne Sigmond, Endocrine Program Manager; Ana Offenheim, Patient Care Coordinator; and me (LL), Clinical Dietitian.<br /><br />Due to time constraints, the delegates had only an hour long visit to the Centre. In a half-hour presentation, the Centre personnel shared information on the diabetes program (program structure, content and focus), and a nutrition management session. Ms. Offenheim presented in English that was translated into Mandarin. I then presented in Mandarin on nutrition management. This created a warm environment close to the delegates’ background so that they could freely express their views, and led to strong, constructive interactions with our foreign guests. Thus, we learned about that multilingual resources and skills are very beneficial in this growing global community.<br /><br />The delegates responded with great enthusiasm and appreciation that we shared our knowledge and counsel for a successful and effective Diabetes Education program. The delegates applauded our efforts and commitment in creating a solid and well structured program, and commended such a wide availability of services. Our multiprofessional approach toward diabetes management was of great interest to the Chinese delegates as China moves in a new direction toward a widely available and well-constructed diabetes education program.<br /><br />One major challenge that the Chinese delegates expressed was that the Chinese healthcare system has a high patient consultation to doctor ratio. Massive patient volumes can make it difficult for physicians to include education in patient care.<br /><br />Acknowledging nutrition management and the Chinese nutritionists’ role as key components in diabetes management, the Chinese delegates were open to new ideas that could successfully lead to positive dietary changes. In recent years, China started to provide professional nutritionist training programs to meet the nation’s growing needs in nutritional management. China and Canada would benefit from sharing nutrition practices and knowledge; such a relationship would help expand professionalism in nutritional care across the two nations.<br /><br />The Chinese delegates showed great interest in advancing their diabetes education resources, especially after reviewing the array of our educational resources. One of their goals was to enhance quality educational materials to meet the learning needs of the Chinese with diabetes.<br /><br />Although the Chinese delegates’ visit to the DEC was brief, it proved to be a successful and rewarding experience for both parties. The Chinese delegations’ appreciation of the visit was well demonstrated in their smiles and the warm expressions on their faces. They wished to learn more about diabetes education and practices in Canada. Before their departure, many of the delegates took pictures with the hosts to bring home the memorable moments of this visit. It was evident that the objective of the Chinese delegates’ visit was fulfilled, and that the visit provided them with knowledge, a Canadian perspective, and insights in advancing diabetes education programs. The DEC care team welcomes and embraces future opportunities to share our knowledge, experience and counsel with China as well as other nations, and looks forward to continuing international collaboration in the growing global community.<br /><br /><br /><br /><br /><p class="MsoNormal" style="font-family:verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">CONTACT:</span></span><span style="color: rgb(51, 102, 102);"><br />Louisa Li, RD, CDE<br />University Health Network<br />Toronto Western Hospital<br />Toronto, ON<br />T: (416) 603-5800 (5968)<br />E: <a href="mailto:Louisa.Li@uhn.on.ca">Louisa.Li@uhn.on.ca</a></span></p><span lang="EN-US" style="font-size:10pt;"><o:p></o:p></span> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><o:p> </o:p></span></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com830tag:blogger.com,1999:blog-7634030145300729360.post-91057257580767773762010-02-06T16:27:00.007-05:002010-02-09T10:25:08.785-05:00Supplemental alpha-tocopherol: A Perspective on Approaching an Evidence-based Project<p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><br /></span></p><p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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). <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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. <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">I highly recommend reading Deborah (Boyko) Wildish’s chapter on micronutrient supplementation (Wildish, 2008), a resource that helped me immensely in my critique.<o:p></o:p></span><br /><p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">Factors considered for each article:<o:p></o:p></span></p> <ul><li><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""><span style="font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal;font-size:7pt;" > </span></span></span><!--[endif]--><span style=";font-family:arial;font-size:10pt;" lang="EN-US">Population being studied<o:p></o:p></span></li><li style="font-family:arial;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""></span></span><span lang="EN-US" style="font-size:10pt;">Type of chronic disease(s) or conditions the participants experienced<o:p></o:p></span></li><li style="font-family:arial;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""><span style="font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal;font-size:7pt;" > </span></span></span><!--[endif]--><span lang="EN-US" style="font-size:10pt;">Form of supplemental E<o:p></o:p></span></li><li style="font-family:arial;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""></span></span><span lang="EN-US" style="font-size:10pt;">Dose and timing (i.e., when was it administered)<o:p></o:p></span></li><li style="font-family:arial;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""><span style="font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal;font-size:7pt;" > </span></span></span><!--[endif]--><span lang="EN-US" style="font-size:10pt;">Study duration<o:p></o:p></span></li><li style="font-family:arial;"><!--[if !supportLists]--><span lang="EN-US" style="font-size:11pt;"><span style=""></span></span><span lang="EN-US" style="font-size:10pt;">Inclusion of other antioxidants e.g., vitamin C, β-carotene<o:p></o:p></span></li><li><!--[if !supportLists]--><span style=";font-family:arial;font-size:11pt;" lang="EN-US"><span style=""><span style="font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; font-size-adjust: none; font-stretch: normal;font-size:7pt;" > </span></span></span><!--[endif]--><span lang="EN-US" style="font-size:10pt;"><span style="font-family:arial;">Outcome measures</span><o:p></o:p></span></li></ul> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">The checklist (p. 190) details factors impacting the strength of study design and quality of evidence. <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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. <o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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!<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><b style=""><span lang="EN-US" style="font-size:10pt;">Project Conclusions<o:p></o:p></span></b><span lang="EN-US" style="font-size:10pt;"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><b style=""><i style=""><span lang="EN-US" style="font-size:10pt;">For Primary Prevention</span></i></b><span lang="EN-US" style="font-size:10pt;">: 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. <o:p><br /></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><b style=""><i style=""><span lang="EN-US" style="font-size:10pt;">Secondary Prevention</span></i></b><span lang="EN-US" style="font-size:10pt;">: 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.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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.<o:p></o:p></span> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><span style="font-weight: bold;"><br /></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><span style="font-weight: bold;">REFERENCES</span><o:p><br /></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">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.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;">Other references available upon request.<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;"><br /></span></span></p><p class="MsoNormal" style="font-family:verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">CONTACT:</span></span><span style="color: rgb(51, 102, 102);"><br />Maria Ricupero, RD, CDE<br />ARAMARK at Toronto Rehab<br />T: (416) 597-3422 (5239)<br />E: <a href="mailto:ricupero.maria@torontorehab.on.ca">ricupero.maria@torontorehab.on.ca</a></span></p><span lang="EN-US" style="font-size:10pt;"><o:p></o:p></span> <p class="MsoNormal" style="font-family:verdana;"><span lang="EN-US" style="font-size:10pt;"><o:p> </o:p></span></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com324tag:blogger.com,1999:blog-7634030145300729360.post-77643307312509461272010-02-01T16:24:00.007-05:002010-02-01T16:34:48.091-05:00Thyroid Cancer, Radioactive Iodine Therapy,and the Low Iodine Diet<p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">Although rare at only 2.6% of all cancers, thyroid cancer incidence is the most rapidly increasing cancer in <st1:country-region st="on"><st1:place st="on">Canada</st1:place></st1:country-region>. Thyroid cancer includes four different types of cancers and predominantly affects young women. It is the most prevalent cancer in Canadian women age 15 - 29 and in adults age 20–39, and is the second most prevalent cancer in adults age 40-49. Thyroid cancer patients have the highest survival rate of all cancers, yet have a high recurrence rate (up to 30%).<br /></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">In December 2007, I underwent a total thyroidectomy for thyroid cancer. The Canadian Thyroid Cancer Support Group (Thry’vors) Inc. provided critical information and much-needed support to me during this difficult time. The main impetus for writing this article is to raise awareness and invite discussion betw een Thry’vors and Registered Dietitians (RDs) on the merits of the Thry’vors Low Iodine Diet (LID)as preparation for radioactive iodine therapy, also known as I-131 remnant ablation (RAI).<o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">Thyroid cancer is typically treated with either a partial or complete thyroidectomy (surgical removal of part or all of the thyroid gland respectively) and often followed by RAI. RAI has been used since 1946, and since the mid-1960s studies have been conducted to investigate the efficacy of the LID in preparation for RAI. These studies have generally concluded that using the LID before, during and just after RAI improves the effectiveness of the treatment.<o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">Patients looking on the Internet for advice are faced with many versions of the LID and a variety of conclusions regarding the ideal duration of the diet, which may be different from what their own doctor is telling them. The Thry’vors LID is a key component of care for thyroid cancer patients when being treated with RAI. It was prepared with the help of more than 50 experts from nutrition and medicine, food manufacturing and labelling, and others.</span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">The LID is a safe, short-term diet (roughly one to two weeks prior to, and a couple of days following RAI) used only in preparation for nuclear medicine thyroid treatment or scan. The main foods to be avoided are iodized salt and any foods prepared with iodized salt, fish and seafood, dairy products, egg yolk, cured meats, soybean products, all restaurant food and all foods or products containing red dye #3. Iodine-free calcium supplementation is an option as the LID is deficient in calcium.<o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">The LID works by emptying the body of its natural iodine stores. When RAI is administered, it puts radioactive iodine into the body. Because thyroid cells require iodine to produce hormones, they pick up the radioactive iodine. This has two outcomes: the radioactive iodine makes any residual thyroid cells visible on the scan, and destroys any remaining thyroid tissue, benign or malignant. The RAI therapy or scan can be compromised if even a relatively minute amount of natural iodine is present in the body. Any natural iodine that may be present will compete with radioactive iodine for entry into the thyroid cells, and may block uptake and limit the effectiveness of the RAI. </span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">In spite of its short-term use, maintaining a LID can be difficult. As patients prepare to undergo RAI, they may experience the following challenges: Patients may: <o:p></o:p></span></span></span></p> <ol><li><span style="font-size:85%;">be simultaneously discontinuing their thyroid replacement medication, therefore they experience the negative effects of being in an induced hypothyroid state (“going hypo”).<o:p></o:p></span></li><li><span style="font-size:85%;">feel frightened about the upcoming treatment and anxious about the required isolation for several days post-therapy. Patients must take certain precautions to minimize the risk of radiation exposure to others, depending on the amount of RAI administered.<o:p></o:p></span></li><li><span style="font-size:85%;">lack confidence to follow the diet as it requires label reading and meal preparation ‘from scratch’ and they may feel they do not have the necessary food skills. <o:p></o:p></span></li><li><span style="font-size:85%;">still be coping with the shock of their cancer diagnosis and recovery from surgery.<o:p></o:p></span></li></ol> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">Thry’vors is reaching out to health professionals across the country to help advocate for the use of the evidenceinformed and patient-friendly Thry’vors LID to be used in preparation for the administration of RAI to thyroid cancer patients. RDs are well-positioned to describe to physicians the evidence supporting the use of the LID, and the key role of the dietitian in explaining the diet to patients. RDs can help people maintain the diet by counselling on preparing food ahead of time, reading labels, and using appropriate foods from their respective cultural food practices. Iodinefree recipes are available on the Thry’vors website (<a href="http://www.thryvors.org">www.thryvors.org</a>/) and from low-iodine cookbooks. <o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">Thry’vors can provide copies of the 2009 Thry’vors Low Iodine Diet, Menu Planner, and Shopping List. To request copies of the LID material, to obtain a list of references used to write this article and for further information, questions or comment, please contact Thry’vors through the website or by emailing me.<o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><br /></span></span></span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style="">REFERENCES - Available upon request.<o:p></o:p></span></span></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><span style=""><span style=""><o:p> </o:p></span></span></span></p> <br /><p class="MsoNormal" style="font-family:verdana;"><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">CONTACT:</span></span><span style="color: rgb(51, 102, 102);"><br />Charna Gord, RD<br />Community Nutritionist<br />Toronto, ON<br />E: <a href="mailto:cgord@sympatico.ca">cgord@sympatico.ca</a></span></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com459tag:blogger.com,1999:blog-7634030145300729360.post-87360991345839194602010-01-18T17:06:00.007-05:002010-01-22T12:32:41.616-05:00Food Banks<span style="font-size:85%;"><span style="font-family:verdana;"><br />On Vancouver Island, the number of people in food bank line-ups has increased dramatically in the past year due to the state of the economy. As the numbers increase, often the amount of food and quality of the food decreases unless a community has the resources to continue to provide enough food to meet the demand.<br /><br /></span><span style="font-family:verdana;">One of the greatest criticisms of food banks is that the food given out is not nutritious. For most food banks, due to inadequate storage space, especially refrigeration, it is difficult to give out anything perishable. Fresh fruit, vegetables and dairy products cannot be stored in large enough volumes to meet the growing demand. Consequently, food banks generally store canned fruit, canned vegetables, canned meats, and peanut butter, along with staples such as flour, sugar, coffee, tea, and grains including rice, pasta and rolled oats. Boxed dried foods like macaroni and cheese dinners, instant soups and dry cereals are also common.<br /><br /></span><span style="font-family:verdana;">In 2007, a local food bank asked me to work with them to review the foods given out and to help develop a menu system that would provide about two days worth of food according to Canada’s Food Guide. This would be especially important for the children that they were serving. We started with Canada’s Food Guide and planned how we could at least partially meet the needs of each family member based on the number of servings from each food group for a specific age. To simplify bagging the groceries, we planned to have only two types of bags. One was an adult bag, the second was a child’s bag. The family would receive one bag for each family member based on their age.<br /><br /></span><span style="font-family:verdana;">We planned a one-month menu and factored in that the food bank operates once per week. In the past, the food bank gave out a bag of donated unrelated tins and boxes of food items and there would sometimes be nothing in the bag that would combine to make a meal. To correct this, food was purchased so that each bag on a given day would be identical. For example, if pasta was given, the bag would contain the sauce with which to make a meal. If there was cereal, it was given on the day milk was available. Recipes were also included.<br /><br /></span><span style="font-family:verdana;">Another nutritional improvement was the realization that for the price of a can of vegetables, a greater quantity of fresh produce could be provided. Every week, families would get a bag of something fresh. These usually included less perishable items such as potatoes, onions, carrots, apples, oranges or bananas. Produce was delivered the day before it was needed and filled the hallways of the food bank. It was all given out the next day so there was no spoilage.<br /><br /></span><span style="font-family:verdana;">As the food bank management team became more aware of the nutritional needs of the clients they were serving, there was a greater willingness to spend a litte extra to meet these needs. For example, the need for extra vitamin D in the winter months was met with an extra milk budget so that the adults would also get some milk as prior to this, only children received milk. The amount of canned fish was also increased.<br /><br /></span><span style="font-family:verdana;">Another wonderful improvement in the quality of food for this food bank was the offer of fresh produce during the summer months. For the past few summers, a community garden has been grown with most of the produce delivered to the food bank on a weekly basis. This is a community partnership where the land was donated by a private business and the garden was planted, tended and harvested as a job skills program. On food bank day, the donated produce is placed outside the food bank on the street like a market stand and clients are asked to help themselves. At the end of the day, the boxes are empty.<br /><br /></span><span style="font-family:verdana;">This past summer, the town decided to grow lettuce and spinach instead of flowers in the municipal flowerbeds. At the first harvest, over 60 pounds of greens were put out on food bank day. Since then, a gleaning program has been started and whole orchards of produce have been donated. On food bank day, locals deliver any unwanted produce to be put out on the street in front of the food bank to fill the market stand. Surplus gleaned produce goes to a pregnancy program and to families at a toddler play program in the community.<br /><br /></span><span style="font-family:verdana;">In spite of a 30 % increase in the number of clients over the past year, this small town food bank continues to be able to meet the needs of their clients due to the generosity of the community and some careful planning with attention to good nutrition. Working together with the community to problem solve food shortages may bring some surprising solutions from unexpected sources. Preparing this article has provided me with a wonderful opportunity to invite discussion about some of the great solutions that must be happening all across Canada.</span></span><br /><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;"><br />CONTACT:</span></span><span style="color: rgb(51, 102, 102);"><br />Eileen Bennewith, RD<br />Community Nutritionist<br />Vancouver Island Health Authority<br />Child, Youth and Family Programs<br />Nanaimo, BC<br />T: (250) 739-5845 ext 57561<br />E: <a href="mailto:Eileen.Bennewith@viha.ca">Eileen.Bennewith@viha.ca</a></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com323tag:blogger.com,1999:blog-7634030145300729360.post-23220260598743207472010-01-04T17:34:00.008-05:002010-01-13T14:43:23.382-05:00Nutrition Education at the Retail Pharmacy<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiijNWg_oKbeJsY04B9WSW03N7W2tor1RgHeVArjWGlCM4f-H6e-ze_n5_scYAz7Zg6VYT4qgYYHz_iKJ5zI5Lu7zmv3IPkQkzDQ6BvQvu7HZSC_ZfyWOrbFo9Gms9NPk3VBMGK9F3Q518-/s1600-h/london-drugs.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 200px; height: 124px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiijNWg_oKbeJsY04B9WSW03N7W2tor1RgHeVArjWGlCM4f-H6e-ze_n5_scYAz7Zg6VYT4qgYYHz_iKJ5zI5Lu7zmv3IPkQkzDQ6BvQvu7HZSC_ZfyWOrbFo9Gms9NPk3VBMGK9F3Q518-/s200/london-drugs.jpg" alt="" id="BLOGGER_PHOTO_ID_5426312334754459394" border="0" /></a><br /><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><b><span style=";font-size:11px;color:black;" ><o:p> </o:p></span></b></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;"><span style="font-weight: bold;">London Drugs is a major pharmacy retailer with 73 stores located throughout Western Canada. Of their large team of pharmacists, a number receive specialized training to attain the designation of Patient Care Pharmacist (PCP).</span> PCPs use their knowledge and skills to provide additional services such as health clinics covering a variety of topics such as heart health, osteoporosis, diabetes, asthma, smoking cessation, and sun care. All clinics include customer assessment and education. Assessments are frequently aided with medical devices such as a blood pressure monitor or blood cholesterol meter for heart health, or a bone densitometer for osteoporosis clinics. Outputs from the device and information gathered during the health interview enable PCPs and customers to have a meaningful health conversation.</span> <span style="color: rgb(0, 0, 0); font-weight: normal;"></span></span></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;">Ongoing customer interest in nutrition issues, particularly weight loss, prompted an exploration of a suitable clinic. I was part of a team of registered dietitians, pharmacists, a medical doctor, and marketing personnel tasked with creating this new clinic. We decided that weight loss per se was too complex a health challenge to adequately tackle and wanted to take a healthy lifestyle approach instead. With this in mind, we determined that body composition analysis would be a suitable assessment tool. We selected a stand-on scale that provided weight, body mass index (BMI), estimated caloric expenditure, body fat, and body muscle. Our team became familiar with the device, its technical outputs, health-related meanings, and its limitations. We felt we could tie aspects of body composition to useful nutrition interventions. We then determined eligibility criteria so as to recruit appropriate customers (i.e., adults with normal/ minimal health issues.) Customers were to be referred to local outpatient or consulting dietitians if their concerns were beyond the scope of the clinic.</span> <span style="color: rgb(0, 0, 0); font-weight: normal;"></span></span></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;">We developed a training program for the PCPs that included how to set up and use the device, how to conduct a basic nutrition assessment, and how to help customers set healthy lifestyle goals. The nutrition assessment was based on a specially designed customer diet history form. PCPs were trained to scrutinize the history for meal frequency, adequacy of food groups, and use of high calorie beverages and “other” foods. PCPs were also trained to deliver nutrition messages using Canada’s Food Guide, the “plate method” of healthy eating, and other straightforward, actionable tools. Physical activity was promoted as well. Educational resources were gathered from Health Canada, the Dairy Farmers of Canada, the Heart and Stroke Foundation, and other respected sources.</span> <span style="color: rgb(0, 0, 0); font-weight: normal;"></span></span></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;">The clinics were offered over the spring and summer, 2009. Analysis of clinic consultations revealed that customer encounters generally lasted 45 minutes and included body composition analysis, explanation of results, discussion of the diet history, trouble shooting, and goal setting. Follow-up visits were conducted six months after the initial visit. The clinics were well received by customers and PCPs alike. Many found the body composition analysis to be quite revealing and others found the lifestyle assessment an excellent starting point for discussion and goal setting. The PCPs enjoyed delivering the clinics and being able to convey a new health message within their scope of practice. The follow-up visit allowed PCPs to develop rapport with customers and provided positive reinforcement regarding his/ her individual goals.</span> <span style="color: rgb(0, 0, 0); font-weight: normal;"></span></span></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;">This interprofessional collaboration created an opportunity for me, a dietitian, to work closely with other health care providers. I was particularly fortunate to learn much more about community pharmacists, their roles, work settings, and scope of practice. Likewise, the pharmacists got to learn about and work with dietitians, a new experience for many of them. Together we determined the appropriate areas of nutrition assessment and education to add to the PCPs previous strengths. This collaboration allowed the creation of a clinic that was custom-made for pharmacists to deliver.</span> <span style="color: rgb(0, 0, 0); font-weight: normal;"></span></span></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="color: rgb(0, 0, 0); font-weight: normal;">We were pleased to have created a unique service in a unique setting (retail pharmacy) that raised the nutrition knowledge of pharmacists and their customers. The service also raised awareness of nutrition education materials and resources (such as Dial-a-Dietitian and Eat Right Ontario), and promoted the registered dietitian as the expert for more challenging nutrition concerns. Thus, while customer demand for “weight loss” drove the creation of the clinic, we chose to meet that demand with a more holistic message of healthy eating and physical activity.</span> </span><br /></span></strong></span></span></p><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span></span></p><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Barbara Allan, RD<br />Consulting Dietitian<br />Richmond, BC<br /></span><span><span style="font-weight: bold;"></span><span style="font-weight: bold;">E</span>: <a href="mailto:bjallan@hotmail.com">bjallan@hotmail.com</a></span></span><br /><span style="font-size:85%;"><span style=";font-family:verdana;font-size:11px;color:black;" ></span></span><span style=";font-family:Verdana;font-size:11px;" ><o:p></o:p></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com558tag:blogger.com,1999:blog-7634030145300729360.post-20702861438941985172009-12-30T15:06:00.004-05:002009-12-30T15:24:26.680-05:00Intern Research: Surveys Aren’t Easy<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt8-X14MueibutzFTAmPMjCqmPOwG7HVHG3zevSeqDkx05EXTfV2jINWojHECJdBLSdMKcnXp1z5jFyGQsUIhSmdcfOOD185sSvdySF-BaUGGdlHC3uVpkjxk40q77cqJTL0vQ8OrvxbzG/s1600-h/survey.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 200px; height: 144px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt8-X14MueibutzFTAmPMjCqmPOwG7HVHG3zevSeqDkx05EXTfV2jINWojHECJdBLSdMKcnXp1z5jFyGQsUIhSmdcfOOD185sSvdySF-BaUGGdlHC3uVpkjxk40q77cqJTL0vQ8OrvxbzG/s200/survey.jpg" alt="" id="BLOGGER_PHOTO_ID_5421127743761141634" border="0" /></a><br /><br /><span style="font-size:85%;"><span style="font-family:verdana;">As a part of our internship, we experienced the thrill, exhaustion and excitement involved in conducting research. As a three-member team, we completed a research project on the knowledge and comfort level of Registered Dietitians (RDs) in recommending vitamin and mineral supplements.<br /><br /></span><span style="font-family:verdana;">The first and most difficult task in completing research was hammering out the research question. It was amazing that one question could lead to so many others. For example, our group spent hours discussing what the word <span style="font-style: italic;">comfort</span> meant to each of us. Defining the research question was an important process to go through, and as an added benefit, we learned a lot about fellow group members.</span> <span style="font-family:verdana;"><br /><br />The literature review revealed little research on the topic of our research question. At first, this made us nervous. However, with time, we realized that it was exciting to be the first to help explore a question key to dietetic practice. The next step was to go through the process of getting ethical approval from Fraser Health and from UBC. In other words, “read the fine print”. This was the part where three ‘big-picture’ people ran into trouble and where detail-oriented people (not on our team) would have thrived.</span><br /><br /><span style="font-family:verdana;">The concept of using a survey to gather information seemed simple, but we learned that it was not. Developing survey questions that asked for the specific information we wanted was very challenging. We discovered that it was extremely valuable to test questions with a focus group as much as possible. We were told (more then once) to avoid double negatives. So, of course, during data analysis we noticed we had still created a question for which the resulting data was a very confusing double negative. Specifically, the result to one of the questions was that ‘RDs are not feeling it was their role to make vitamin and mineral supplement recommendations’. Confused yet?</span> <span style="font-family:verdana;"><br /><br />In our overzealous excitement and eagerness, we ended up asking too many questions that were interesting of course, but did not actually help us answer the research question we had set out to answer or to address our research objectives. For example, our research question</span> <span style="font-family:verdana;">was registered dietitians’ practices in recommending vitamin and mineral supplements. We asked questions about the barriers that prevent RDs from making vitamin/mineral recommendations and what sorts of things would help them improve their comfort level. </span><span style="font-family:verdana;">Although it was very hard to leave some questions out of our results and discussion, having to do so suggested that there are many unanswered questions around this topic.</span> <span style="font-family:verdana;"><br /><br />In general, the research process for our group involved the following things: approximately 10,000 emails, several 1:00 a.m. conference calls, about 100 to-do lists, a couple dinner parties, and a pretty satisfying end-result.</span> <span style="font-family:verdana;"><br /><br />Overall, we found the research component of internship very challenging and interesting. We gained an appreciation for people who contribute to furthering the dietetic profession by completing research, and learned the basics of how to complete a research project from</span> <span style="font-family:verdana;"> beginning to end. That being said, the most important things that we learned were how to be effective group members and how <span style="font-weight: bold;">not</span> to do surveys.</span> <span style="font-weight: bold;font-family:verdana;" ><br /><br />ACKNOWLEDGMENTS</span> <span style="font-family:verdana;"><br />Karol Traviss, RD for helping us through the process of survey development. Dr. Cathy Morley, RD for helping us find our way out of that huge mess of data. Liz Da Silva, RD and Sian-Hoe Cheong,</span> <span style="font-family:verdana;">RD for being there every step of the way.</span> <span style="font-family:verdana;"></span></span><br /><br /><p class="MsoNormal" style=""><span style="font-size:85%;"><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span></span></p><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Jaclyn Smith, RD(t)<br />New Westminster, BC<br /></span><span><span style="font-weight: bold;">T: </span> (778) 397-2087<br /><span style="font-weight: bold;">E</span>: <a href="mailto:Jaclyn.Smith@fraserhealth.ca">Jaclyn.Smith@fraserhealth.ca</a></span></span><br /><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Co-researchers:<br />Damaris Campbell, RD(t) and<br />Jill Wallace, RD(t)</span></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com430tag:blogger.com,1999:blog-7634030145300729360.post-42393128509930191812009-12-03T12:46:00.014-05:002009-12-11T19:26:24.529-05:00Beyond Nutritionism – An Invitation to Critical Dietetics Dialogue<span style="font-family:verdana;"><span style="font-size:85%;">In spring of 2009 a research workshop entitled "Beyond Nutritionism: Rescuing Dietetics through Critical Dialogue" was held at Ryerson University and funded by the Social Sciences and Humanities Research Council. Appropriately, for a springtime gathering, it marked the establishment of a new movement - </span><span style="font-weight: bold;font-size:85%;" >Critical Dietetics</span><span style="font-size:85%;">.<br /><br /></span><span style=";font-family:verdana;font-size:85%;" >At the workshop, leading international theorists, researchers, practitioners, students, and advisors had long-awaited conversations regarding gender, race, class, ability, size, dietetic epistemology, post-structural orientations to dietetic education, art, and poetry in the context of dietetics. The result was an animated, groundbreaking commitment to redefine the profession through Critical Dietetics.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" >What counts as “knowing” in dietetic practice? How do we, as nutrition professionals, come to know what we don’t know? How does the evidenced-based culture of dietetics give voice? Where does dietetic culture render silence? What is it that we have already accomplished as a profession? In what ways do we continue to evolve? How can we further build upon the rich roots of our profession? What do we envision for the future of our profession? These are but a few of the difficult, essential questions that Critical Dietetics seeks to explore.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" >Critical Dietetics takes courage as we depart from familiar ways of doing and knowing. Indeed as Simmons (2009) challenged us in an earlier edition of Practice, it is time to “expand” (p.3) our dietetic identities to become more “pluralistic” (p.3), as we move beyond mere nutritionism (Pollan, 2008) in our work.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" >Critical Dietetics requires conviction for change, comfort with the uncertainty of not knowing, acceptance of the blurry divide between art and science, and a desire for our allies’ knowledge in social sciences, humanities and natural sciences with whom we have much to integrate. We can grapple with the limits of science alongside the imperative to use it, and venture into the vulnerability evoked by the merging of personal and professional ways of knowing.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" >We are authors of our own experience and supportive witnesses to one another’s growth in the midst of this new terrain.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" ><span style="font-weight: bold; font-style: italic;">Critical Dietetics: A Declaration</span> stands as testament to the commitment the initial group has forged. It is extended as an invitation to our colleagues to become companion dietetic explorers in this exciting new movement. Together we can expand the body of knowledge in dietetics and shape the future of our profession.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" ><span style="font-weight: bold;">REFERENCES</span><br />Pollan M. (2008). <span style="font-style: italic;">In defense of food: An eater’s manifest</span>o. New York: The Penguin Press.<br />Simmons D. (2009). <span style="font-style: italic;">Questioning my Dietitian identity.</span> Practice, 46, 3.</span><span style="font-size:85%;"><br /><br /><span style="font-weight: bold;font-size:130%;" ><br /></span></span><span style="font-weight: bold;font-family:verdana;font-size:100%;" ><span>Critical Dietetics - A Declaration – June 2009</span></span><span style="font-size:85%;"><br /><br /></span><span style="font-family:verdana;"><span style="font-size:85%;">Dietetics is a diverse profession with a commitment to, and tradition of, enhancing health, broadly defined, through diet and food. We recognize the commitment and hard work undertaken by dietetic professionals of the past and present who continue to innovatively shape and reshape the profession from its roots in home economics to the incorporation of contemporary perspectives on health. While recognizing the multiple meanings of food and its power to nourish and heal, we acknowledge that food is more than the mere sum of its constituent nutrients. We recognize that human bodies in health and illness are complex and contextual. Moreover, we recognize that the knowledge that enables us to understand health is socially, culturally, historically, and environmentally constructed.<br /><br /></span><span style=";font-family:verdana;font-size:85%;" >Building on the past century of dietetics and the “Beyond Nutritionism”workshop held at Ryerson University June 12-14, 2009, we extend an invitation to individuals in all areas of dietetics education, practice, and research to collaborate on the Critical Dietetics initiative.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" ><span style="font-weight: bold; font-style: italic;">Critical Dietetics</span> is informed by transdisciplinary scholarship from the natural sciences, social sciences, and the humanities. By contributing to scholarship, practice, and education, it strives to make visible our assumptions, give voice to the unspoken, embrace reflexivity, reveal and explore power relations, encourage public engagement and diverse forms of expression, and acknowledge that there are no value-free positions. Through these principles, Critical Dietetics will engage with the ever-changing health, social, and environmental issues facing humanity.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" >Assuming a critical stance means remaining inquisitive and willing to ask and hear challenging questions. Critical approaches grant us permission to imagine new ideas and explore new ways of approaching our practice. Critical Dietetics creates space for an emancipatory (i.e., liberating and socially just) scholarship by drawing upon many perspectives, philosophies, orientations, ways of asking questions, and ways of knowing.</span><span style="font-size:85%;"><br /><br /></span><span style=";font-family:verdana;font-size:85%;" ><span style="font-weight: bold; font-style: italic;">Critical Dietetics</span> derives its strength from supportive relationships, recognizing that it takes courage to step beyond familiar ways of knowing. It invites constructive dialogue and challenges us to discuss, debate, and rethink what we know and how we know it. It is a generative and collective effort which understands that strength comes from diversity and debate. This declaration is therefore a bold invitation that welcomes different ways of thinking and practicing within our own profession and in collaboration with allied fields. We anticipate collectively expanding the body of knowledge in dietetics and continuing the inclusive, scholarly, collective, and pluralistic development of the profession. If you want to contribute to this dialogue and become a signatory of Critical Dietetics, please email your expression of interest to <a href="mailto:jgingras@ryerson.ca">jgingras@ryerson.ca</a> by January 7, 2010.</span><br /><br /><p class="MsoNormal" style=""><span style="color: rgb(51, 102, 102);"><span style="font-size:85%;"><span style="font-weight: bold;">Sincerely,</span><br /><br /><span style="font-weight: bold;">Lucy Aphramor (UK) BSc, RD</span><br /><span style="font-weight: bold;">Yuka Asada MHSc, RD</span><br /><span style="font-weight: bold;">Jennifer Atkins MHSc, RD</span><br /><span style="font-weight: bold;">Shawna Berenbaum PhD, RD, FDC</span><br /><span style="font-weight: bold;">Jenna Brady BA, BASc, MHSc</span><br /><span style="font-weight: bold;">Shauna Clarke (UK) BA, MA</span><br /><span style="font-weight: bold;">John Coveney (Australia) MPHEd, PhD</span><br /><span style="font-weight: bold;">Marjorie DeVault (USA) PhD</span><br /><span style="font-weight: bold;">Lisa Forster-Coull MA, RD</span><br /><span style="font-weight: bold;">Ann Fox MHSc, PhD, RD</span><br /><span style="font-weight: bold;">Jacqui Gingras PhD, RD</span><br /><span style="font-weight: bold;">Charna Gord MEd, RD</span><br /><span style="font-weight: bold;">Mustafa Koc PhD</span><br /><span style="font-weight: bold;">Esther Ignagni MSc</span><br /><span style="font-weight: bold;">Daphne Lordly RD</span><br /><span style="font-weight: bold;">Debbie MacLellan PhD, RD, FDC</span><br /><span style="font-weight: bold;">Elizabeth Manafo MHSc, RD</span><br /><span style="font-weight: bold;">Catherine Morley MA, PhD, RD, FDC</span><br /><span style="font-weight: bold;">Dean Simmons MSc(c), RD</span><br /><span style="font-weight: bold;">Karen Trainoff BASc, RD</span><br /><span style="font-weight: bold;">Roula Tzianetas MSc, RD</span><br /><span style="font-weight: bold;">Jennifer Welsh MSc</span><br /><span style="font-weight: bold;">Kristen Yarker-Edgar MSc, RD </span><br /></span></span></p> </span></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com532tag:blogger.com,1999:blog-7634030145300729360.post-66142974225919122362009-11-05T11:56:00.012-05:002009-11-18T14:34:05.012-05:00CINDAR – A Useful Tool for Dietetics Researchers, Practitioners and Students<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkrvKguor5wLH3M6YplLoa51FgqQZzc7l2xc1PVVWCI9FwhnSJ8RAAVEEJ-bWb2GvsWhcpB1JClwG9ltBjsR9w7seXirEM4DH-xocHpkZ22QX0R5L2ZCGa_bdRTbWiFU-UDQqwmPTHX3nH/s1600-h/cindar.gif"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 320px; height: 196px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkrvKguor5wLH3M6YplLoa51FgqQZzc7l2xc1PVVWCI9FwhnSJ8RAAVEEJ-bWb2GvsWhcpB1JClwG9ltBjsR9w7seXirEM4DH-xocHpkZ22QX0R5L2ZCGa_bdRTbWiFU-UDQqwmPTHX3nH/s320/cindar.gif" alt="" id="BLOGGER_PHOTO_ID_5400665443557967890" border="0"></a><br /><font size="2"><font face="verdana"></font><font face="verdana">Have you had an opportunity to use the Canadian Inventory of Nutrition and Dietetic Associated Research (CINDAR) lately? If not, please check it out.</font><br /><br /><font face="verdana">CINDAR is an online resource of dietetic and nutrition research activities. Through this database, researchers can share their work with others and learn who else is doing related research. CINDAR is unique in that it enables users to share updates and to learn about research that is currently in progress. CINDAR also informs practitioners, educators, policy makers, and industry leaders about the nutrition and dietetic research in progress.</font><br /><br /><font face="verdana">CINDAR was developed in 1997 by Dietitians of Canada with funding from CFDR. Currently, both the Canadian Society for Nutritional Sciences and the Canadian Society of Clinical Nutrition also provide their members with access to CINDAR through direct links on their websites. </font><br /><br /><font face="verdana">The value of CINDAR is in the information contributions of the community of dietetics and nutrition researchers in Canada. Researchers input their latest projects and update their progress as they achieve major milestones in their work. The database presents research summaries when users search by investigator or by key words that the researchers themselves have identified. Directions are available to help users profile their research, upload a CV or photo, or simply create a description of their work for the site. The database also allows for direct links to other websites where more information can be found about the researchers and their work. </font><br /><br /><font face="verdana">CINDAR is a useful database of research projects in many practice areas. Currently, there are hundreds of research projects profiled on CINDAR covering a vast array of research projects. Topics include obesity, infant nutrition needs, disease-specific nutrition interventions, dietetics education, and projects enhancing the profession.</font><br /><font face="verdana"><br />CINDAR can be used for a variety of purposes. For example:</font> </font><ul><li><font size="2"><font face="verdana">If you are interested in a particular field of research, you can enter a keyword to find research projects in this area. You might find answers to practice questions.</font></font></li><li><font size="2"><font face="verdana">If you want to collaborate with someone on a research project, you can find a researcher who is interested in the same type of research.</font></font></li><li><font size="2"><font face="verdana">If you want to find more information about a specific dietetic researcher, you can search on the researcher’s last name to learn about projects they have done.</font></font></li></ul><font size="2"> <font face="verdana"><br />CINDAR is an excellent resource for dietetics students. Kayla Glynn, MHSc, RD, Internship Coordinator, Division of Food and Nutritional Sciences Graduate Program in Foods and Nutrition at Brescia University College (University of Western Ontario), instructs students on the value of CINDAR. Kayla says, “Our MScFN (Internship Stream) has prepared Guidelines for the MScFN Major Research Project. The guidelines clarify the intern’s responsibilities regarding dissemination of their research. We expect our MScFN interns to submit their research projects to CINDAR. We hope that our graduates appreciate that this aspect of dissemination is a way to give back to the profession while acquiring valuable recognition at the start of their careers.”</font> <font face="verdana"></font><font face="verdana"><br /><br />For more information on CINDAR, please visit the CFDR website at <a href="http://www.cfdr.ca/cindar.html">www.cfdr.ca/cindar.html</a>.</font> <font face="verdana"><br /><br /></font></font><p class="MsoNormal" style=""><font size="2"><font style="" size="4" face="verdana"><strong><font style="color: rgb(51, 102, 102);">Contact<br /></font></strong></font></font></p><font style="color: rgb(51, 102, 102);"><font style="font-weight: bold;">Isla Horvath<br /></font><font><font style="font-weight: bold;">T: </font> (519) 267-0755<br /><font style="font-weight: bold;">E</font>: <a href="mailto:ihorvath_cfdr@dietitians.ca">ihorvath_cfdr@dietitians.ca</a></font></font><br /><font face="verdana"><br /></font>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com330tag:blogger.com,1999:blog-7634030145300729360.post-26232736044713455262009-10-30T15:44:00.006-04:002009-11-05T10:56:56.560-05:00Community Partnership Involving Dietetic Interns: A Public Health Nutrition Experience<font style="font-weight: bold;" face="verdana">Background</font><br /><br /><font face="verdana">Partnership is one of the core functions in public health practice. The partnership described in this article arose from a joint commitment of bringing community nutrition and chronic disease prevention work into a community agency, the Patch Project1 (Hull Child and Family Services), whose nutrition programming was focused on emergency food access. This article describes what we did and provides perspectives of different partners including staff of the Patch Project, the University of Alberta Integrated Dietetic Internship Program (UA-IDIP), and Health Agency registered dietitian (RD) preceptors.</font> <font style="font-weight: bold;" face="verdana"><br /><br />What We Did</font><br /><br /><font face="verdana">We took an asset-based approach and conducted an inventory of current community based programming focused on nutrition. The Patch Project advised on the program areas of most relevance to the populations they served. Dietetic interns were key participants in this initial work. During their placements with health agencies they researched the unique needs of the population that the Patch Project served. The work was primarily health agency driven and the outputs included adaptations to the format and delivery of existing resources to address the needs of diverse populations. </font> <font face="verdana"><br /><br />The partners had shared values, goals and expectations around accessibility and appropriateness of existing programs and seeking opportunities to model healthy eating in non-health agency programming, rather than seeking initiative funding and/or creating new/temporary resources with limited sustainability. All partners concurred that the goals could be achieved by placing an intern directly with the Patch Project thus optimizing use of preceptors’ areas of expertise while providing dietetic interns with practical experiences in community nutrition work with at-risk populations. The health agency RDs mentored the intern in developing community and public health nutrition competencies including how to appropriately utilize nutrition standards, approaches and resources in working with at-risk populations. </font> <font face="verdana"><br /><br />The foundational work spent on building the partnership and the ongoing evaluation led to a decision to pilot a 12-week intern placement at the community agency. Additional components to the established internship placement process were developed including a community agency screening of the intern, intern orientation binder, and scheduled opportunities for partner communication (e.g., weekly meetings, template for weekly intern reflection reports).</font> <font style="font-weight: bold;" face="verdana"><br /><br />Participants’ Reflections</font> <font style="font-weight: bold; font-style: italic;" face="verdana"><br /><br />Patch Project, Hull Child and Family Services: </font> <font face="verdana"><br />We experienced more nutrition modelling, education, and skill building in our agency programming that clearly stimulated an interest in healthy eating. Nutrition was introduced in practical ways within achievable limits. A challenge is how to manage and sustain the ideas/ programming after the placement ended. Our goal is to integrate nutrition considerations into our practice.</font> <font style="font-weight: bold; font-style: italic;" face="verdana"><br /><br />Internship Coordinator (UA –IDIP): </font> <font face="verdana"><br />This placement was in a non-traditional setting and was a way to offer hands-on experience for interns in community nutrition. Adding new (non-traditional) placements to the internship increases the number of meaningful placements available to interns and allows them to gain experience in nutrition education, needs assessment, program planning, implementation and evaluation.This particular placement also provided learning opportunities related to food insecurity.</font><br /><br /><font style="font-weight: bold; font-style: italic;" face="verdana">Dietetic Intern (UA –IDIP): </font> <font face="verdana"><br />Since I was directly immersed within a low-income, multicultural community during this placement, I was able to appreciate the work that goes into a community development project. I have always been interested in community nutrition and now I have had the opportunity to work on a community garden and to develop a community nutrition program.</font><br /><br /><font style="font-weight: bold; font-style: italic;" face="verdana">Health Agency RDs – Alberta Health Services</font> <font style="font-weight: bold; font-style: italic;" face="verdana"><br />(Nutrition Services, Population and Public Health);</font> <font style="font-weight: bold; font-style: italic;" face="verdana"><br />Healthy Babies Network, Catholic Family Services:</font><br /><font face="verdana">Placing a dietetic intern in a community agency allowed for a person with nutrition expertise to participate in hands-on work. The shared responsibility of preceptorship and combined perspectives of Dietitians in public health and community nutrition broadened the scope of practice for the intern. This successful pilot placement is seen as a model that can support community level work. Because of the Patch Project’s commitment to health promotion we have been able to consult with them for a community perspective on other initiatives.</font> <font style="font-weight: bold;" face="verdana"><br /><br />Conclusion</font> <font face="verdana"><br /><br />The internship placement described in this article is one example of the important role of partnerships in public health nutrition work. We believe that an open and transparent partnership, with common values and goals, where all partnership work is valued and where challenges are addressed from an asset-based approach has been central to the successful outcomes.</font> <font face="verdana"><br /><br /><font size="2"><font style="font-style: italic;">1 The Patch Project is a grassroots, community based program serving families that live in subsidized housing units located in high needs communities.</font></font></font> <font style="font-weight: bold;" face="verdana"><br /><br /><br />ACKNOWLEDGEMENTS</font><font face="verdana"> – Thank you to all partners in supporting this experience: Patch Project (David Wright, Christina Maes, Twyla Mudry, Teresa Rumdit, Stacey McRae, Claire Jackson); UA-IDIP (Carrie Mullin-Innes); UA-IDIP intern (Sandra Paquette); Alberta Health Services (Kathy Cunningham); Healthy Babies Network (Brinda Rao). </font> <font face="verdana"><br /><br /></font><p class="MsoNormal" style=""><font style="" face="verdana" size="4"><strong><font style="color: rgb(51, 102, 102);">Contact<br /></font></strong></font></p><p class="MsoNormal" style=""><font style="color: rgb(51, 102, 102);"><font style="font-weight: bold;">Nutrition Services, Population and Public Health<br /><br />Alberta Health Services - Calgary, AB</font></font></p><font face="verdana"></font><font style="color: rgb(51, 102, 102);"><font style="font-weight: bold;">Suzanne Galeslott</font><font>, MSA, RD<br /><font style="font-weight: bold;">T: </font> (403) 943-6752<br /><font style="font-weight: bold;">E: </font><a href="mailto:suzanne.galesloot@albertahealthservices.ca">suzanne.galesloot@albertahealthservices.ca</a></font></font><br /><br /><font style="color: rgb(51, 102, 102);"><font style="font-weight: bold;">Annette Li<br /></font><font><font style="font-weight: bold;">T: </font> (403) 355-3290<br /><font style="font-weight: bold;">E</font>: <a href="mailto:annette.li@cancerboard.ab.ca">annette.li@cancerboard.ab.ca</a></font></font><br /><font face="verdana"><br /></font>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com285tag:blogger.com,1999:blog-7634030145300729360.post-52002081534790630852009-10-23T15:00:00.007-04:002009-10-26T11:52:23.214-04:00Assessing Nausea and Vomiting of Pregnancy<p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">My strong interest in pregnancy lead me to study the most common medical condition during this life stage, nausea and vomiting of pregnancy, during my Nutritional Assessment course at the <st1:place st="on"><st1:placetype st="on">University</st1:placetype> of <st1:placename st="on">Guelph</st1:placename></st1:place>. I was amazed to learn how two symptoms can have such severe consequences in a woman’s pregnancy and life. This article provides information on the nature of nausea and vomiting of pregnancy (NVP), and methods developed to assess symptom severity, nutritional status and dietary intake.</span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span><span style="font-size:85%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">NVP affects almost 80% of all pregnant women (Goodwin, 2002). Although not usually life threatening, it has a negative effect on a woman’s quality of life during pregnancy (Attard et al., 2002). The severity of NVP ranges between mild nausea and uncontrollable vomiting requiring hospitalization. The most severe form, hyperemesis gravidarum, occurs when NVP progresses to severe vomiting and is characterized by decreased dietary intake (Smithells et al., 1977), dehydration, electrolyte imbalance, and weight loss of >5% of body weight (Fairweather, 1968; Emelianova et al., 1999). Symptoms of NVP usually occur during the first trimester, <span style=""> </span>however, some women experience symptoms for longer (Goodwin, 2002). Assessing the nutritional status and symptoms of nausea and vomiting in pregnant women is important to ensure a healthy pregnancy and optimal quality of life. Symptoms can be assessed using clinical assessment instruments, while anthropometric and dietary measures are used to monitor nutritional status.</span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span><span style="font-size:85%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">The severity of nausea and vomiting can be assessed using a validated questionnaire to quantitatively assess the severity of subjective symptoms (Rhodes et al., 1999). The Rhodes Index of Nausea and Vomiting Form-2 (INV-2) is a validated eight-item self-report instrument that measures the physical symptoms and stress caused by NVP (<st1:place st="on">Rhodes</st1:place> et al., 1984). This instrument has been reformatted to a more efficient, reliable and user-friendly version called the Index of Nausea, Vomiting, and Retching (INVR) (Rhodes et al., 1999). Although this instrument is appropriate for clinical assessment and research, it was created and validated with a respondent sample of people experiencing nausea and vomiting in cancer chemotherapy (Koren et al., 2001). The Motherisk Program in <st1:city st="on"><st1:place st="on">Toronto</st1:place></st1:city> found the INVR instrument cumbersome and time-consuming (Koren et al., 2001). Motherisk developed the Pregnancy Unique-Quantification of Emesis (PUQE), a self-administered instrument with only three items (length of nausea; number of vomits; number of retching episodes) that can be easily performed in all clinical and research settings (Koren et al., 2002). The PUQE scoring system specific to NVP was validated independently (Koren et al., 2005). The major limitation to both the INVR and PUQE scoring systems is that they cover symptoms occurring in the preceding 12 hours and cannot measure NVP severity for a longer period of time (Lacasse et al., 2008). The modified-PUQE is a validated instrument to quantify symptoms occurring from the start of pregnancy (Lacasse et al., 2008). A study conducted by Koren et al. through the Motherisk counselling telephone line showed modified-PUQE scores to be more severe than the 12-hour PUQE. This can be explained by a recall bias produced by a retrospective evaluation of NVP symptoms (Koren et al., 2004).<o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">Anthropometric measures are used to assess pregnancy weight gain with self-reported height and weight and scale measurements. Self-reported height and weight are used to generate an accurate representation of true pre-pregnancy BMI, that is used as a baseline for measuring weight gain (Brunner Huber, 2007). While self-reported weight is usually underestimated and height is usually overestimated in women of reproductive age, Brunner Huber (2007) found that selfreported measurements used to calculate BMIs accurately classified women into a BMI category as assessed through scale/measured values. The Institute of Medicine (IOM) recommended using BMI measurements to assess weight gain during pregnancy (IOM, 1990). Weight measured using a calibrated, electronic scale should be compared to the IOM recommendations for weight gain within a particular BMI category. Weight is an easy measurement; however, it can be affected by time of day, bladder fullness, and clothing choice (Gibson, 2005). It has been reported that BMI is not a better predictor of maternal and perinatal morbidity than body weight alone (Wolfe, 1991). For now, the IOM guidelines are appropriate as the literature shows that adherence to the guidelines will result in low risk of an adverse pregnancy (DeVader et al., 2007).</span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span><span style="font-size:85%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">Energy intake is assessed by a 24-hour recall (Van Stuijvenberg et al., 1995) using a multiple-pass interviewing technique and food models to assist clients to recall their intake, and to accurately estimate portion sizes (Gibson, 2005). The multiple-pass 24-hour recall is so called because interviewers obtain dietary information through ‘multiple passes’ during the interview process using a quick list, detailed description and a final review (Tran et al., 2000). A limitation to using multiple-pass 24-hour recalls with women is that energy intake is often underestimated (Tran et al., 2000). Twenty-four hour recalls are preferred for woman experiencing NVP as they are physically and emotionally unwell, and there is lower respondent burden compared to maintaining (un)weighed food records (Gibson, 2005).<br /></span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span><span style="font-size:85%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;">From researching the development of a questionnaire for assessing the clinical symptoms of nausea and vomiting of pregnancy, I have a greater understanding and appreciation for the time and effort that goes into each questionnaire used by health professionals.</span></p><p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><br /></span><span style="font-size:85%;"><o:p></o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><o:p> </o:p></span></p> <p class="MsoNormal" style="font-family:verdana;"><span style="font-size:85%;"><b>REFERENCES </b>available from Janis Randall Simpson.</span></p><br /><p class="MsoNormal" style=""><br /></p><p class="MsoNormal" style=""><span style=";font-family:verdana;font-size:130%;" ><strong><span style="color: rgb(51, 102, 102);">Contact<br /></span></strong></span></p><p class="MsoNormal" style=""><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;"><br /></span></span></p><p class="MsoNormal" style=""><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Lindsay Ball, BSc, BASc</span></span></p><p class="MsoNormal" style=""><br /><span style="color: rgb(51, 102, 102);"><span style="font-weight: bold;">Janis Randall Simpson, PhD, RD (advisor)<br />Unvierstiy of Guelph<br />E: <a href="mailto:rjanis@uoguelph.ca">rjanis@uoguelph.ca</a></span></span><br /><span style=";font-family:ArialMT;font-size:10;" ><o:p></o:p></span></p>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com301tag:blogger.com,1999:blog-7634030145300729360.post-47877479256142108582009-10-14T11:59:00.008-04:002009-10-14T12:29:07.351-04:00Self-Running PowerPointTM Presentations –– Part 1<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcGujFWYvUEDzk-UzYVnsyPUXPCoNdmeG5Db_IYJKKbbx_mVk0o4GPT-JYOjNiBgfesmu7jmip8ZOMHrBBR7YYla-000yPPdvbL11OXaLkdczf44_xVc3h_s_AC95c65BXh5HZL1bxPvYF/s1600-h/P.jpg"><img id="BLOGGER_PHOTO_ID_5392490950123794450" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 144px; CURSOR: hand; HEIGHT: 139px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcGujFWYvUEDzk-UzYVnsyPUXPCoNdmeG5Db_IYJKKbbx_mVk0o4GPT-JYOjNiBgfesmu7jmip8ZOMHrBBR7YYla-000yPPdvbL11OXaLkdczf44_xVc3h_s_AC95c65BXh5HZL1bxPvYF/s320/P.jpg" border="0" /></a><br /><span style="font-family:verdana;font-size:85%;">Have you every wanted to be in two places at once? Now you can with self-running PowerPoint<sup>TM</sup> presentations (SRPP). Minimal computer skills and time are required to record your voice into a presentation and create a PowerPoint<sup>TM</sup> show that can run on any computer. This article describes the potential applications and process for developing SRPP.<br /><br /><strong>Applications</strong><br />The potential applications for SRPP are limitless. I have provided a few examples; use your imagination to come up with more.<br /><br /><strong><em>Interns:</em></strong> An orientation presentation would introduce interns to the institution/work area. Details on assessment forms, specific wards, names and photos of key employees, etc. could be included. This would significantly reduce the time commitment for preceptordietitians to orient students.<br /><br /><strong><em>Clients:</em></strong> If you find that you repeat the same information to each client, make a presentation with the repetitive information, and spend more time helping clients integrate the information into their daily lives.<br /><br /><strong><em>Staff:</em></strong> Getting the staff together for a training session can be a challenge – a SRPP can be watched at one or more convenient times.<br /><br /><strong><em>Continuing Education:</em></strong> The Art & Science of Food Hypersensitivity – Online Training for Dietitians is an example of how to use SRPP in continuing education. See an example of using this approach at <a href="http://www.foodallergynews.com/">http://www.foodallergynews.com/</a>.<br /><br /><strong><em>Meetings:</em></strong> If you can’t attend a meeting to present your idea, you can connect with the group by telephone and send an SRPP for the group to watch.<br /><br /><strong><em>Proposals:</em></strong> A dynamic and creative SRPP can get your ideas across more persuasively than a written document.<br /><br /><strong></strong></span><br /><span style="font-family:verdana;font-size:85%;"><strong>Sharing Your Presentation</strong><br /></span><br /><span style="font-family:verdana;font-size:85%;">There are two options for sharing your presentation, either keep the presentation as a PowerPoint<sup>TM</sup> presentation file, and after it is opened, choose slide show view, or save the presentation as a PowerPoint<sup>TM</sup> Show and the presentation will start playing as soon as the file is opened.<br /><br />If the destination computer does not have the PowerPoint<sup>TM</sup> program installed, a PowerPoint<sup>TM</sup> viewer can be downloaded from the Microsoft<sup>TM</sup> website. Recording audio into a presentation greatly increases the file size, making it difficult to e-mail.<br /><br />SRPPs can be transferred to another computer using a file transfer service, also known as an FTS. There are many services available on the Internet (e.g., YouSendIt<sup>TM</sup>). Generally, files that are under 100MB (approximately 20 minutes of SRPP) can be sent without a charge, but larger files or advanced options require a fee. The process is simple – you upload the file to the Internet and send the recipient the link so they can download the file to their computer. Alternatively, the SRPP can be copied to a disk, memory stick or external hard drive and physically transferred to the destination computer.<br /><br />Many organizations record live presentations with a video camera for educational purposes. I find creating a SRPP is much more effective because the presenter can read from notes to get the exact wording and animation timing, something that is difficult to achieve with a live presentation. Another advantage is that it is very easy to update one slide with a SRPP. </span><br /><br /><hr /><br /><span style="font-family:verdana;font-size:85%;"><strong>Developing a SRPP</strong> </span><br /><span style="font-family:verdana;font-size:85%;">1. Create your PowerPoint<sup>TM</sup> presentation.<br />2. Attach a microphone to the computer.<br />3. From the Slide Show Menu, choose Record Narration. From that dialogue box, click on name and select the quality of recording. ’CD’ is the best quality, but creates the largest file size.<br />4. Advance your slides and talk into the microphone. When you are ready to stop, press Esc and Save.<br />5. You can start again from any slide, and individual slides can be re-recorded.<br />6. When the presentation is in ‘slide show view’, the slides will automatically advance with the presenter’s voice. Note: If the<br />PowerPoint<sup>TM</sup> file is used for a live presentation, delete the audio (in the custom animations box) and in the Slide Show – Set up Slide Show choose advance slides manually. Practice to make sure the settings are correct or you may have a nasty surprise!<br />7. Animations will be recorded, but actions during the presentation (e.g., mouse movements or writing with the pen) will not.<br /></span><br /><hr /><span style="font-family:verdana;font-size:85%;"><br />Part 2 of this topic in the next issue of Practice will be about techniques to convert a SRPP to video and to upload to the Internet. </span><br /><br /><br /><br /><span style="font-family:verdana;font-size:130%;"><strong><span style="COLOR: rgb(51,102,102)">Contact<br /></span></strong></span><br /><span style="COLOR: rgb(51,102,102)"><span style="FONT-WEIGHT: bold">Wendy Busse, RD, MSc<br />Red Deer, AB<br />T: (403) 986-5267<br />E: <a href="mailto:wendybusse@foodallergynews.com">wendybusse@foodallergynews.com</a><br /></span></span>PRACTICE NEWSLETTERhttp://www.blogger.com/profile/07583551777518342514noreply@blogger.com502