Dietetic practice in the management of gestational diabetes mellitus: A survey of Australian dietitians

Aim: To examine current Australian dietetic practice in the management of gestational diabetes, to identify models of dietetic care and to determine the need for national evidence‐based dietetic practice guidelines for gestational diabetes. Methods: A 55‐item cross‐sectional survey of Australian dietitians practicing in the area of gestational diabetes was undertaken. Participants were recruited via Dietitians Association of Australia interest group membership, public and private hospital maternity and diabetes services across Australia. The survey examined dietetic service provision, interventions, management recommendations, postnatal care, current guideline use and the perceived need for Australian evidence‐based dietetic management guidelines. Results: A total of 220 eligible dietitians participated in the survey. The majority (77%) reported that all women with gestational diabetes attending their service were referred to a dietitian. Group (33%) and individual consults (93%) were provided and 67% provided one to two dietetic consults per client. Fifty‐four per cent (54%) believed that their service currently offered adequate antenatal dietetic interventions and 8% adequate postnatal follow up for women with gestational diabetes. There were differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. However, consistency was seen in key components of nutrition education. Dietitians perceived that there was a need for evidence‐based gestational diabetes dietetic practice guidelines (86%) and nutrition recommendations (87%). Conclusion: The survey results strongly indicate there is a need for evidence‐based gestational diabetes practice guidelines and nutritional recommendations and provide baseline data for future practice of Australian dietitians working in gestational diabetes.     

HOW COMMON IS PROSTATITIS? A NATIONAL SURVEY OF PHYSICIAN VISITS

Purpose

We used a national data base to explore the epidemiology of physician visits for genitourinary symptoms or a diagnosis of prostatitis.

Materials and Methods

We analyzed 58,955 visits by men 18 years old or older to office based physicians of all specialties, as included in the National Ambulatory Medical Care Surveys from 1990 to 1994. Physicians selected by random sampling completed visit forms that included information on patient reasons for visits and physician diagnoses.

Results

From 1990 to 1994, 5% of all ambulatory visits by men 18 years old or older included genitourinary symptoms as a reason for the visit. In almost 2 million visits annually prostatitis was listed as a diagnosis, including 0.7 million by men 18 to 50 years old and 0.9 million by those older than 50 years. Of the prostatitis visits 46 and 47% were to urologists and primary care physicians, respectively. A prostatitis diagnosis was assigned at 8 and 1% of all urologist and primary care physician visits, respectively. The odds of a prostatitis diagnosis were 13-fold greater at visits to urologists compared with visits to primary care physicians, and approximately 2-fold greater in the south than in the northeast. Surprisingly, compared with men 66 years old or older, prostatitis was more commonly diagnosed in men 36 to 65 than men 18 to 35 years old. When a prostatitis diagnosis was given, antimicrobial use was likely to be reported 45% of the time for men with and 27% for those without genitourinary symptoms. Visits to primary care physicians were more often associated with antimicrobial use than visits to urologists.

Conclusions

Genitourinary symptoms are a frequent reason for office visits by younger and older men, and prostatitis is a common diagnosis. Despite a report that less than 10% of prostatitis cases are bacterial, a much higher proportion of men in whom prostatitis is diagnosed receive antimicrobials.