This issue (22.2) focuses on some of the tools and techniques to enhance clinical nutrition practices including the problem-based approach in graduate nutrition, advanced technological application, and measurement of indirect calorimetry. Pilot studies and practice projects also provide new strategies for helping practitioners.
Lohse and Shafer approached the teaching of dietetics students in 7 graduate nutrition courses, using problem-based learning. The evaluative design examined student self-perceptions of clinical competencies, learning and cognitive behaviors, attitudes toward problems tested, and time requirements. The mean examination scores were increased by 10%, and other dimensions were reported and interpreted in comparison to the medical and nursing literature.
Advanced technologies in dietetic practice have been addressed by Charney. From her literature review she concludes (and we concur): "At minimum, dietitians should have a broad understanding of informatics in healthcare as well as basic technologic skills needed to support use of technology in the workforce."
A comparative study was conducted using the Deltatrac metabolic cart and a handheld, indirect calorimetry device in 14 extremely obese women by Dobratz et al. They found that the handheld device did not provide clinical accuracy as well as the metabolic cart for estimating resting energy expenditure in extremely obese women.
Edelstein assessed the value of a 1-hour training session on diversity with 178 dietitians. The tolerance of Ambiguity questionnaire was administered to compare pretest and posttest scores. She found more tolerance of differences (ambiguity) at posttest. Additional study is needed to address the education of today's professionals so that they may serve more diverse students and clients.
Gastrich et al did an extensive review of recent studies that assesses the impact of added sugar in the diet. Although definitive studies are needed with comparable methods, the studies reviewed from 1987 to 2006 indicate that excessive sugar in the diet increases the risk of obesity and chronic conditions, such as diabetes and cardiovascular disease.
The research by Hunt et al revealed important, long-term counseling points for those patients considering laparoscopic gastric bypass. Dietitians are encouraged to provide balanced information that clearly details expected lifestyle changes so that patient expectations of surgery results are realistic. Realistic expectations lay the groundwork for lasting satisfaction among patients and can lead to a higher quality of life after laparoscopic gastric bypass surgery.
Sneed et al reconfirmed the value of mentorship in all areas and specifically in creating, implementing, and maintaining a HACCP program in Iowa assisted living facilities. More training, employee retention, and time are keys to successful food safety practices and HACCP implementation.
The low-carbohydrate trend inspired Condon et al to assess practices, knowledge, and attitudes of 165 collegiate athletes. No differences in the mean scores of nutrition knowledge or attitudes were found between men and women. However, female athletes reported more frequent carbohydrate restrictions. They concluded that athletes should have education on the importance of carbohydrate intake related to athletic performance.
Robertson and her colleagues conducted a pilot study with 33 participants and 19 controls with type 2 diabetes mellitus that examined the use of a culturally appropriate Web site to record lifestyle characteristics and food intake. They were able to document better control of HbAlc for those who recorded data on the Keya Tracker Web site. This innovative approach certainly warrants a larger study based on their assessment of finding a viable tool to assist with lifestyle changes for individuals with type 2 diabetes.
Judith A. Gilbride, PhD, RD, FADA
Editor