American Society for Parenteral and Enteral Nutrition and American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nutrition Support

The Standards of Practice for Registered Dietitians in Nutrition Support and the Standards of Professional Performance for the Registered Dietitian in Nutrition Support are key resources for RDs at all knowledge and performance levels. These standards can and should be used by RDs in daily practice to consistently improve and appropriately demonstrate competency and value as providers of safe and effective nutrition support therapy. The standards development and evaluation process is dynamic—these standards will be reviewed at least every 5 years for applicability to practice. Current and future initiatives of A.S.P.E.N. and ADA will provide information that will be used in these updates and in further clarifying and documenting the specific roles and responsibilities of practitioners at each level. As a quality initiative of A.S.P.E.N., its Dietetics Practice Section, ADA, and their DNS DPG, the standards themselves are an application of continuous quality improvement concepts and represent another very important collaborative endeavor.     

Nutrition in elderly dialysis patients

The end-stage renal disease (ESRD) population is aging, and currently approximately 50% of patients treated with maintenance dialysis are more than 65 years old. With advancing age comes challenges to maintaining the nutritional status of these patients. As patients get older, purchasing and preparing food may become more difficult. In addition, appetite may decrease, the occurrence of intercurrent illnesses may become more frequent, and nutrient requirements change. Mobility may decline, as well as cognitive function, and the combination of several of these factors may result in malnutrition. Since malnutrition has been demonstrated to impact survival in dialysis patients of all ages, appropriate attention to nutritional status and its management is essential for the elderly dialysis patient. This article reviews the issues associated with the maintenance of good nutrition in the elderly dialysis patient and describes the potential causes of malnutrition in these patients. It also reviews the nutrient requirements for older dialysis patients (which differ somewhat from those of younger patients), as well as the assessment of their nutritional status. Finally, recommendations for management of nutrition in the elderly dialysis patient are discussed.     

A new method and device to induce transient retinal ischemia in the rat

PURPOSE: To describe and characterize a novel, non-invasive method to induce retinal ischemia in the rat. METHODS: Retinal ischemia was produced by applying a compression force with a suture thread anchored about 2mm behind the limbus of the eye in order to increase intraocular pressure and reduce ocular blood flow. Both ends of the suture thread were connected to weights via a pulley system. The effect of various weights (20, 25, or 35 g) on retinal damage was tested in animals of different body weights (350 and 574 g). Scotopic ERG measurements and histological sections of retinal tissue were used to evaluate possible functional and morphological changes to the retina as a consequence of ischemia followed by reperfusion. RESULTS: Retinal ischemia was achieved by this method with good reproducibility. The degree of retinal damage, as quantified by ERG measurement, correlated with the amount of weight connected to the suture thread. Seven days after 60 minutes of retinal ischemia, the amplitudes of A- and B-waves of eyes compressed with a 20 g weight were 84 +/- 11% and 86 +/- 16% (mean +/- SEM, n = 4, amplitudes before ischemia defined 100%), respectively. The A- and B-wave amplitudes of eyes compressed with 25 g were 69 +/- 7% and 76 +/- 6% (n = 11), respectively. A 35 g treatment produced A- and B-wave amplitudes of 55 +/- 3.9% and 52 +/- 4% (n = 35), respectively. There was no significant difference in the level of ischemic damage in the two groups of animals with different body weights evaluated in this study. At two weeks after 60-minute retinal ischemia, there was a significant decrease (by 31.1%) in the cell density in the retinal ganglion cell layer. CONCLUSIONS: The pulley method is an easy, non-invasive, and highly reproducible technique for inducing retinal ischemia in rats. This procedure may provide a useful animal model of ischemic retinopathy.     

Ecstasy: America's new "reefer madness"

MDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, "Ecstasy" had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government reports of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.