Animal experimentation – a personal view

Disagreement about the use of animals in biomedical research has resulted in absurd positions by both sides. Increasingly, some zealots against animal experimentation have resorted to violence or other illegal acts to support their points of view. The value of animal research in providing better health for man and animals is incontrovertible. This is illustrated by references to animal research in the field of nutrition.     

Workplace learning and career progression: qualitative perspectives of UK dietitians

Background

Post‐graduate education and continuous professional development (CPD) within dietetics lack clearly defined pathways. The current literature primarily focuses on new graduate perceptions of workplace learning (WPL). The present study raises issues of how CPD is sustained throughout a National Health Service (NHS) career, how informal learning might be made more visible and whether the workplace withholds learning opportunities.

Methods

Qualified dietitians participated in focus groups (n = 32) and a nominal group technique (n = 24). Data from audio recordings were transcribed and triangulated. Thematic analysis took an interpretative approach.

Results

One size for WPL for dietetics and, likely, other allied health professionals (AHPs) did not meet the learning needs of everyone. The informal implicit learning affordances often went unrecognised. A greater emphasis on teaching, picking up on the strong preference for discussion with others voiced in the present study, may improve recognition of all WPL opportunities. Better scaffolding or guided support of entry level dietitians may ease the transition from study to workplace and challenge any perception of ‘clipped wings’. Where development and career progression proves difficult for experienced dietitians, mentoring or stepping outside the NHS may revitalise by providing new communities of practice.

Conclusions

WPL cannot be understood as a unitary concept. Dietitians engage with WPL differently across their careers. Future visions of WPL, especially explicit post‐graduate career and education frameworks, must accommodate these differences to retain the highest calibre dietitians. The implications of a period of learning ‘maintenance’ rather than CPD among experienced dietitians offers a topic for further research, particularly as the workforce ages.

     

Protection of personal data--the European view

A new series of laws are being passed to control the processing of personal information--including medical information--inside the European Commonwealth. The author gives an overview of the European view of personal information and examines the implications for healthcare professionals both here and abroad.     

Free radicals and antioxidants: updating a personal view

This article looks back to the antioxidant/free radical field in 1994 and discusses how it has progressed in the past 18 years. In some areas, there has been little change: the role of oxygen radicals and other reactive oxygen species (ROS) in the origin or progression of most human diseases remains uncertain, with cancer and neurodegenerative disease being likely exceptions. Even in diseases in which ROS are involved there has been little progress in developing effective antioxidant treatments. Mega-doses of dietary antioxidants have also generally failed to prevent human disease, in part because they do not decrease oxidative damage in vivo (as revealed by robust biomarkers). However, some strategies that are known to delay disease onset may act, at least in part, by decreasing oxidative damage levels. Nevertheless, far more is known today about endogenous antioxidant defenses and how they are regulated, which has led to a deeper understanding of how some ROS can act as signaling molecules. Increasing endogenous antioxidant levels (e.g., by supplying "pro-oxidants") may be a better approach to therapeutics and disease prevention than consuming large doses of "dietary antioxidants."     

Clearance of asbestos bodies from the lung: a personal view.

In histological sections asbestos bodies in human lungs may be either transparent, yellow, strongly Perls-positive structures as described in published reports, or opaque, black structures, the ferroprotein coating having been converted into haemosiderin. The transparent asbestos bodies fragment into segments; the black asbestos bodies disintegrate into a mass of haemosiderin granules that accumulate as dense deposits, particularly near to blood vessels. The presence of haemosiderin granules indicates that asbestos bodies have broken down. When a patient has died with a mesothelioma there is little evidence of phagocytic activity in many areas of the lung. When exposure to asbestos ceased many years before a mesothelioma developed there may be few recognisable asbestos bodies remaining in the lung.     

Parenteral nutrition. Do dietitians have a role? Results of the Parenteral and Enteral Nutrition Group survey

Aim: To examine the role of the nutrition support dietitian in parenteral nutrition (PN).
Methods: Two postal surveys were sent to members of the Parenteral and Enteral Nutrition Group (PENG) in 1993 and 1995. The questionnaires were designed to examine four key areas of dietetic practice in PN.
Results: Response rates of 73% in 1993 and 75% in 1995 were achieved. In 1993, a minority of dietitians, only 5%, assumed total responsibility for the formulation of parenteral nutrition regimens. In 1995 this figure had risen to 14%. However, 83% of nutrition support dietitians wanted to increase their involvement in PN. Results from the 1995 survey showed that 42% of dietitians felt that education at undergraduate level was inadequate, whilst 58% felt education at postgraduate level could be improved.
Conclusion: Both surveys raised a number of issues concerning present prescribing practices of PN in the UK. There appears to be little practical clinical nutrition education concerning PN either in the medical, dietetic or pharmaceutical curriculum. This may indicate that present prescribing practices are suboptimal. Because dietitians are involved in nutritional assessment and calculation of nutritional requirements it would seem sensible that dietitians should have a greater prescribing role in PN. In order to become competent advisors in this area, more must be done to improve education for dietitians at the undergraduate and postgraduate levels, otherwise the opportunity to be actively involved in this area may be lost.     

Audit of dietary input into a hospital lipid clinic

Patients attending a lipid clinic demonstrated a fall in blood cholesterol level averaging 17% and a weight reduction averaging 3.2 kg (7.13 lbs) in the first 3 months after intensive dietary advice. The cost of maintaining a patient on diet and drugs was calculated to be approximately £601 year, compared with only £35 on diet alone. Of the £35, only £5.20 relates to dietetic costs which makes dietary therapy the most cost-effective part of the management of hypercholesterolaemia.     

Patient‐reported dietetic care post hospital for free‐living patients: a Canadian Malnutrition Task Force Study

Background

Transitions out of hospital can influence recovery. Ideally, malnourished patients should be followed by someone with nutrition expertise, specifically a dietitian, post discharge from hospital. Predictors of dietetic care post discharge are currently unknown. The present study aimed to determine the patient factors independently associated with 30‐days post hospital discharge dietetic care for free‐living patients who transitioned to the community.

Methodology

Nine hundred and twenty‐two medical or surgical adult patients were recruited in 16 acute care hospitals in eight Canadian provinces on admission. Eligible patients could speak English or French, provide their written consent, were anticipated to have a hospital stay of ≥2 days and were not considered palliative. Telephone interviews were completed with 747 (81%) participants using a standardised questionnaire to determine whether dietetic care occurred post discharge; 544 patients discharged to the community were included in the multivariate analyses, excluding those who were admitted to nursing homes or rehabilitation facilities. Covariates during and post hospitalisation were collected prospectively and used in logistic regression analyses to determine independent patient‐level predictors.

Results

Dietetic care post discharge was reported by 61/544 (11%) of participants and was associated with severe malnutrition [Subjective Global Assessment category C: odd's ratio (OR) 2.43 (1.23–4.83)], weight loss post discharge [(OR 2.86 (1.45–5.62)], comorbidity [(OR 1.09 (1.02–1.17)] and a dietitian consultation on admission [(OR 3.41 (1.95–5.97)].

Conclusions

Dietetic care post discharge occurs in few patients, despite the known high prevalence of malnutrition on admission and discharge. Dietetic care in hospital was the most influential predictor of post‐hospital care.