Computer-based simulations enhance clinical experience of dietetics interns

OBJECTIVE

To determine the impact of computer-based simulations on the performance of dietetics interns in initial clinical rotations.

DESIGN

Interns used either a simulation program (Care Planning Simulation System CPSS[) or a computer-based tutorial (Nutrition Care Planning Tutorial NCPT[) during their orientation. Performance of these interns on nutrition care skills was evaluated during their initial clinical rotations.

SUBJECTS/SETTING

Participants were 108 dietetics interns from 8 different programs. Each internship had at least 8 interns, and none of the internships awarded a graduate degree.

INTERVENTION

Subjects in the experimental group completed nutrition assessment and care planning activities for 3 simulated patients. Subjects in the control group completed a tutorial on assessment and care planning.

MAIN OUTCOME MEASURES

Likert scale ratings of 31 behaviors were recorded by clinical preceptors. Behavior statements were grouped into 8 categories and average ratings for each category were determined.

STATISTICAL ANALYSIS

Repeated-measures analysis of variance and linear regression were used to compare performance ratings between groups.

RESULTS

There were no differences in overall evaluations of the simulation and tutorial groups for the 8-week period. Interns who started clinical rotations immediately after orientation (CPSS-I and NCPT-I groups) were rated lower in all categories than those who began their clinical rotations later (CPSS-D and NCPT-D groups). Maturation and acquisition of general skills likely influenced ratings of interns with delayed clinical rotations. For most categories of behavior the rate of improvement in rating scores was greatest for interns who used CPSS.

APPLICATIONS

Computer-based simulations are a promising supplement to current techniques in didactic instruction and may be useful in both didactic and practice settings. Computer-based simulations can provide more varied practice experiences to didactic students and interns in preparation for more skilled entry-level positions in dietetics.

Phosphate-binding capacity of ferrihydrite versus calcium acetate in rats

Calcium salts, such as calcium carbonate and calcium acetate, are the principal compounds used as phosphate binders in patients with chronic renal failure. The dose required is three to six times the normal requirement for calcium. Use of these large doses of calcium salts in the diet can result in hypercalcemia. Other compounds have been investigated as phosphate binders with varying degrees of success. Synthetic ferrihydrite (5Fe(2)O(3).9H(2)O) has a high adsorptive capacity for phosphate and may be an effective phosphate binder. The phosphate-binding capacity of ferrihydrite was compared with that of calcium acetate in 250-g male Sprague Dawley rats. After an overnight fast, rats (n = 5 per group) were gavaged with an American Institute of Nutrition (AIN) 76 formula containing one third the daily phosphorus intake labeled with phosphorus-32 ((32)P). Either two levels of calcium acetate, representing three (1/2X) or six (1X) times the usual calcium intake for one third of the day, or equivalent amounts of ferrihydrite were added to the diet. An additional group received two times (2X) the larger dose, and a sixth control group received no binder in the diet. Phosphorus absorption curves were determined from (32)P appearance in the serum. The 1/2X dose of ferrihydrite reduced (32)P by approximately one half, and the 2X dose nearly completely suppressed (32)P absorption, similar to the 1X dose of calcium acetate. The advantage of using a ferrihydrite binder would be to avoid the hypercalcemia resulting from the use of high-dose calcium salts. An added advantage may result from the small amounts of iron absorbed in these chronically iron-deficient patients.

Dietary conjugated linoleic acid normalizes impaired glucose tolerance in the Zucker diabetic fatty fa/fa rat

Conjugated linoleic acid (CLA) is a naturally occurring fatty acid which has anti-carcinogenic and anti-atherogenic properties. CLA activates PPAR alpha in liver, and shares functional similarities to ligands of PPAR gamma, the thiazolidinediones, which are potent insulin sensitizers. We provide the first evidence that CLA is able to normalize impaired glucose tolerance and improve hyperinsulinemia in the pre-diabetic ZDF rat. Additionally, dietary CLA increased steady state levels of aP2 mRNA in adipose tissue of fatty ZDF rats compared to controls, consistent with activation of PPAR gamma. The insulin sensitizing effects of CLA are due, at least in part, to activation of PPAR gamma since increasing levels of CLA induced a dose-dependent transactivation of PPAR gamma in CV-1 cells cotransfected with PPAR gamma and PPRE X 3-luciferase reporter construct. CLA effects on glucose tolerance and glucose homeostasis indicate that dietary CLA may prove to be an important therapy for the prevention and treatment of NIDDM.

Essential fatty acid deficiency in renal failure: can supplements really help?

Abnormal fatty acid metabolism may contribute to clinical problems such as itching, abnormal perspiration, susceptibility to infection, delayed wound healing, anemia, and increased hemolysis, as seen in patients with chronic renal failure. A double-blind study of patients on hemodialysis who received either fish oil, olive oil, or safflower oil documented that patients may have increased levels of the proinflammatory prostaglandin PGE2 and that fish oil intervention may decrease these levels, change the fatty acid profile, improve hematocrit levels, and improve patient perception of symptoms of pruritus.

Effect of three sources of long-chain fatty acids on the plasma fatty acid profile, plasma prostaglandin E2 concentrations, and pruritus symptoms in hemodialysis patients

Patients with chronic renal failure exhibit plasma fatty acid patterns indicative of essential fatty acid deficiency. The plasma fatty acid profile of 25 hemodialysis patients with a history of pruritus symptoms indicated lower 20:3n-9 (eicosatrienoic acid), 20:4n-6 (arachidonic acid), and 20:5n-3 (eicosapentaenoic acid) concentrations; a higher 18:1n-9 (oleic acid) concentration; and above-normal ranges of prostaglandin E2 (PGE2) compared with 22 subjects chosen from a normal population. No significant difference in 22:6n-3 (docosahexaenoic acid) was shown between the hemodialysis patients and the normal subjects. The dietary intake of 20:5n-3 was higher and that of 18:1n-9 lower in the patients compared with the normal population group. In this 8-wk double-blind study the hemodialysis patients were randomly assigned to receive daily supplements of 6 g ethyl ester of either fish oil, olive oil, or safflower oil. At the end of 8 wk of treatment the fish oil group (FO group) had a greater decrease in 18:1n-9 (P < 0.05), greater increases in 20:5n-3 and 22:6n-3 (P < 0.01), and trends toward a greater decrease in 20:4n-6, a greater increase in PGE2 concentrations, and greater improvement in pruritus scores (0.10 > P > 0.05) compared with the other two groups. The increases in 20:5n-3 and 22:6n-3 in the FO group indicate compliance with fish oil supplementation. Results indicate that hemodialysis patients have abnormal fatty acid profiles and increased PGE2 values. Fish oil intervention changes the fatty acid profile and may improve the symptoms of pruritus.

Hypnotherapy in the treatment of bronchial asthma

The efficacy of hypnotherapy in aborting acute asthmatic attacks was studied in 17 children ranging in age from six to 17. All had as their primary diagnosis bronchial asthma. Prior to hypnotic induction pulmonary function was assessed, then monitored in the immediate post hypnotic period and at two intervals thereafter. The average improvement for all subjects was greater than 50% above the baseline measurement as documented by spirometry, monitored dyspnea, wheezing and subjective ratings by the subjects. It is suggested that hypnotherapy may be an important tool in ameliorating asthma, improving ventilatory capacity and promoting relaxation without recourse to pharmacologic agents. One explanation offered is that hypnosis affects an automic response, thereby diminishing bronchospasm.