Background: Patients who follow a very low calorie diet using meal replacements show significant weight loss. For long-term weight maintenance, combination therapy may provide additional help for ...long-term results. This study followed 37 patients who completed five years of follow up treatment using phentermine and health care visits. Methods: Thirty-two women and five men, ages 25-70 years of age, enrolled in the study and completed the protocol. Only patients who completed five years in long-term maintenance of this protocol were studied. Initially patients had lost weight on a very low calorie diet using meal replacements. Initial weight loss on the very low calorie diet was variable. After at least eight weeks, the patients were then transitioned to a low calorie diet and prescribed phentermine (18.75-37.5 mg/day). The maintenance diet included meal replacements and food. The follow up visits were every 2-4 weeks for five years with a physician and registered dietitian. Physicians provided the medical monitoring and the dietitians, the nutritional counseling, motivation, and support. Results: 37 patients completed five years of the maintenance study. Mean baseline weight was 220.9 lbs, and at the end of the very low calorie diet was 197.5 lbs. (11% weight loss). At the end of five years, mean weight was 203.2 (8.1% weight loss). Mean baseline BMI was 39.2 and at the end of five years was 33.9. Mean blood pressure was 131/8 at baseline and 128/78 at five years. Although mean total cholesterol did not change from baseline, HDL was 55 mg/dl at baseline and increased to 63 mg/dl at five years. Five of the 37 patients did not see the RDN for nutriional counseling during maintenance visits. No adverse events were noted in these patients. Conclusions: Patients who completed the five year study- very low calorie diet using meal replacements, followed by the use of phentermine showed a medically significant weight loss. Combined with the follow up visits by the physician and dietitian, this provided continuity of care for these patients. Although no significant changes were noted in the other variables, small sample size could have contributed. Dropouts were not included in this study, and should be reviewed for reasons for lack of continuing. Follow up analysis will compare these patients to those who did not finish the protocol.
Resumo Introdução: A importância da atuação do nutricionista em unidades de diálise é indiscutível e obrigatória no Brasil, porém pouco sabemos sobre as práticas adotadas por esses profissionais. ...Objetivo: Conhecer práticas adotadas na rotina dos atendimentos nutricionais, com foco nas ferramentas de avaliação nutricional e nas estratégias de tratamento das pessoas com risco ou diagnóstico de desnutrição. Metodologia: Questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens. Incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, utilização e frequência de ferramentas de avaliação nutricional, estratégias de intervenção nutricional em casos de risco ou diagnóstico de desnutrição e prescrição e acesso a suplementos alimentares orais. Resultados: Foram recebidos eletronicamente o equivalente a 24% das unidades de diálise brasileiras (n = 207). As ferramentas de avaliação nutricional mais utilizadas com ou sem frequência pré-estabelecida foram inquéritos dietéticos (96%) e Avaliação Global Subjetiva (83%). As estratégias em casos de risco ou presença de desnutrição utilizadas com mais frequência (quase sempre/sempre) foram a orientação de incremento energético e proteico por meio de alimentos (97%) e o aumento da periodicidade das visitas (88%). A frequência de prescrição de suplemento industrializado de fórmula padrão e especializada foi bastante semelhante. A disponibilização de suplementos alimentares pelo Sistema Único de Saúde aos pacientes variou entre as regiões. Conclusão: A maior parte dos nutricionistas utiliza diversas ferramentas de avaliação nutricional e estratégias de intervenção em casos de risco ou desnutrição, porém a frequência de utilização de tais ferramentas e estratégias foi bastante variada.
ABSTRACT Introduction: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. Objective: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. Methodology: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians’ demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. Results: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. Conclusion: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.
Background: Mentorship for health care professionals is used to offer guidance, knowledge, and transfer experience. Clinical Dietitians (CD) play a key role in diabetes care. Offering mentorship ...might help build their confidence levels (CL) and grow the profession with the goal of improving outcomes and experiences for people living with diabetes (PWD). The objectives are, in CD (1) to assess the need for mentorship in diabetes and (2) to gather opinions on the structure and content for appropriate mentorship.
Methods: A 28-question online survey was developed, piloted with 8 CD through cognitive interviewing, and shared with CD across the province of Quebec (Canada). Descriptive analysis was used to determine the proportions (%) in survey responses, stratified by years of clinical experience (CE).
Results: From the 284 participants (97% women, mean age 31+/-10 years), 275 (97%) of CD identified a need for mentorship in diabetes. Desire to participate and in what function (mentee, mentor or both) was dependent on the years of CE. Formal mentorship was preferred by 41%, 30% informal and 29% a combination of both which was independent of the years of CE. Finally, 93.5% believe their confidence level in providing care for PWD would increase if they participated in mentorship.
Conclusion: Mentorship in diabetes was perceived as needed to increase Clinical Dietitians confidence level in caring for PWD and for interprofessional collaboration.
Disclosure
S.Blunden: Employee; Dexcom, Inc. A.Roy-fleming: None. C.South: None. C.Gillis: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.
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