- Email: [email protected]
Identifying Attitudes of Healthcare Professionals toward Obese Individuals in a Hospital Setting
SUNDAY, OCTOBER 4
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Impact of the Outpatient Registered Dietitian-Nutritionist (RDN) on Body Weight Status in Patients Undergoing a Total Pancreatectomy with Auto-Islet Cell Transplant (TP-IAT) Author(s): M. Nestleroad1, D.M. DellaValle2, S.M. Owczarski3, E.P. Shuford1, K.A. Morgan3, D.B. Adams3; 1Digestive Disease Center, Med. Univ. of South Carolina, Charleston, SC, 2Department of Medicine, Division of Gastroenterology/Hepatology, Med. Univ. of South Carolina, Charleston, SC, 3Department of Gastrointestinal and Laparoscopic Surgery, Med. Univ. of South Carolina, Charleston, SC Learning Outcome: Participants will be able to describe the nutrition-related outcomes that the outpatient RDN can impact in patients undergoing a Total Pancreatectomy with Auto-Islet Cell Transplantation. Total Pancreatectomy and Islet Auto-Transplantation (TP-IAT) is a surgical treatment for the debilitating pain of chronic pancreatitis (CP). There are no evidence-based nutrition guidelines or medical nutrition therapy (MNT) recommendations for this population. Patients with CP have alterations in gastrointestinal physiology and nutrient uptake and utilization. Literature reviews and clinical practice support the concept that patients undergoing TP-IAT benefit from perioperative intervention by a Registered DietitianNutritionist (RDN). The aim of this retrospective chart review was to assess the impact of dedicated perioperative, outpatient RDN intervention on the body weight (BW) status of patients that have undergone TP-IAT over the past 5 years (n¼126, 76% female). Change in BW was assessed before and at 6 months and 12 months after surgery. We compared a group that received dedicated outpatient perioperative RDN intervention (n¼27) to a random sample that did not receive outpatient RDN intervention (n¼ 22). On average, the total sample lost 7.5 10.5 kg at 12 months post-surgery. Over the entire 12-month period, patients exposed to outpatient RDN intervention were better able to maintain their BW compared to the no-RDN group (-2.36.4 vs -12.511.4 kg, p¼0.01 for the time-by-group interaction). After controlling for baseline BW and ferritin, the group exposed to outpatient RDN intervention, maintained BW at 12 months compared to the no-RDN group which lost 17.8 kg over 12 months (p¼0.008). RDNs in an outpatient setting dedicated to patients undergoing TPIAT can positively impact BW status when MNT is provided perioperatively.
Relationship between Subjective Global Assessment and Functional Independence Measurements among Acute Rehabilitation Patients Author(s): M.V. Betz, S. Peterson, D. Sowa; Food and Nutrition, Rush Univ. Med. Ctr., Chicago, IL Learning Outcome: Participants will be able to identify the role of nutrition in acute rehabilitation patient outcomes. Patients admitted to acute rehabilitation are often malnourished with low muscle mass and may have loss of functionality. The purpose of this quality improvement project was to determine if malnutrition is associated with Functional Independence Measurement (FIM) scores in acute inpatient rehabilitation patients. Mean age, BMI and percent malnourished derived from Subjective Global Assessment (SGA) were collected upon admission to acute inpatient rehabilitation. FIM scores, an ordinal scale of functional assessment, were collected from physical therapy (PT) and occupational therapy (OT) records upon admission and discharge. Mann-Whitney U tests were used to compare median FIM scores between subjects categorized as normal versus moderately/severely malnourished. Analysis included 97 patients with a mean age of 64 and BMI 29 kg/m2; 36% were malnourished. At admission, FIM scores were significantly higher in well-nourished patients compared to malnourished for PT (4.5 vs. 4.33, p¼0.012), OT (4.5 vs. 4.2, p¼0.05) and combined scores (4.55 vs. 4.19, p¼0.025). A similar trend was observed at discharge for PT (5.92 vs. 5.50, p¼0.003), OT (5.89 vs. 5.00, p<0.001) and combined PT/OT (5.93 vs. 5.13, p<0.001). More patients who were well-nourished reached independence level (45.5% vs. 11.4%). In addition, more patients who were malnourished were discharged to a skilled nursing facility or acute care (39% vs. 8%, p<0.001). Well-nourished patients performed better for both PT/OT at admission and discharge. Additionally, well-nourished patients were more likely to be discharged home. These results highlight the importance of nutrition in ability to complete activities of daily living in acute rehabilitation. Funding Disclosure: None
Funding Disclosure: None Identifying Attitudes of Healthcare Professionals toward Obese Individuals in a Hospital Setting
Impact of Ketogenic Diet Therapy on Carnitine Concentrations in Children with Intractable Epilepsy
Author(s): J. Turker, T. Crook, J. Phelps, R. Hakkak; Dietetics and Nutrition, Univ. of Arkansas for Med. Sci., Little Rock, AR
Author(s): J.E. Riebold1, C. Wray2, P. Haskell3, M. Gillingham1, D. Stadler1; Graduate Programs in Human Nutrition, Oregon Hlth. & Sci. Univ., Portland, OR, 2Pediatric Neurology, Oregon Hlth. & Sci. Univ., Portland, OR, 3 Oregon Hlth. & Sci. Univ., Portland, OR
Learning Outcome: Participants will be able to describe the attitudes of healthcare professionals toward obese patients in order to identify education and training needs for those caring for obese individuals. Obesity remains a national and global epidemic. Consequently, healthcare professionals are serving numerous obese patients every day. Studies indicate healthcare professionals hold negative attitudes toward obese patients, which could impact the quality of care they receive. Thus, the purpose of this study was to determine the attitudes of nursing professionals toward obese patients in order to identify education and training needs for staff working with these individuals. An online survey was completed by 228 nurses and nursing students at a medical center in Arkansas. The survey included the Fat Phobia Scale, a validated tool that assessed the participants’ negative attitudes toward obese individuals. One-way between groups analysis of variance (ANOVA) and independent-samples t-tests were used to determine if differences existed in fat phobia scores based on age, gender, practice area, years’ experience and body mass index (BMI) category of the participants. There were no significant differences in fat phobia scores based on age, gender, practice area or years’ experience; however, scores were significantly higher in participants with lower BMIs compared to those with higher BMIs (M¼ 3.5, SD¼ 0.46; M¼ 3.3, SD¼ 0.58, respectively), indicating that participants with lower BMIs had more negative feelings toward obese patients. These data indicate that healthcare professionals possess negative attitudes toward obese individuals, which could negatively impact the care they receive. Future research should focus on the education and training needs for nurses and other healthcare professionals caring for obese individuals in order to deliver the best possible care to this population. Funding Disclosure: None
1
Learning Outcome: Participants will be able to describe the impact of ketogenic diet therapy on carnitine concentrations in children with intractable epilepsy. The ketogenic diet (KD) effectively reduces seizure frequency in some children with intractable epilepsy (IE). Many centers routinely supplement with carnitine as an adjunct therapy during KD treatment in an attempt to optimize fatty acid oxidation for ketogenesis. However, there is insufficient evidence to support routine carnitine supplementation on a broad scale for these children. Therapeutic doses of carnitine may be cost-prohibitive and poorly tolerated, and these patients may maintain adequate carnitine status without intervention. We evaluated the effect of the classic KD (about 80-90% fat) on carnitine status in the absence of supplementation by assessing fasting plasma free and total carnitine concentrations in 14 children, 1 month-13 years of age, with IE before and during the first 12 months of treatment. Mean (SE) plasma free and total carnitine concentrations were 27.0 (2.3) and 43.5 (2.9) umol/L, respectively, before KD initiation. Relative to baseline, mean plasma total carnitine concentration increased 4.9 umol/L (95%CI: 1.9-7.9; p¼0.001) or 9.6% (95%CI: 4.0-16%) at 3 month intervals for the first 12 months of treatment. Mean free carnitine concentration did not vary significantly over time (p¼0.118). Despite these collective trends, six children had at least one free and three children had at least one total plasma carnitine concentration below established reference ranges during KD treatment. No overt signs of carnitine insufficiency (weakness, fatigue, or cardiomyopathy) were noted in any cases. These results suggest that the KD can impact plasma carnitine concentrations and that carnitine should be assessed and supplemented in some children during KD treatment. Funding Disclosure: Herbert D. and Nyelda Gemple Research Grant; Pediatric Nutrition Practice Group Research Award (Academy of Nutrition & Dietetics Foundation)
September 2015 Suppl 2—Abstracts Volume 115 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-27
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Impact of the Outpatient Registered Dietitian-Nutritionist (RDN) on Body Weight Status in Patients Undergoing a Total Pancreatectomy with Auto-Islet Cell Transplant (TP-IAT) Author(s): M. Nestleroad1, D.M. DellaValle2, S.M. Owczarski3, E.P. Shuford1, K.A. Morgan3, D.B. Adams3; 1Digestive Disease Center, Med. Univ. of South Carolina, Charleston, SC, 2Department of Medicine, Division of Gastroenterology/Hepatology, Med. Univ. of South Carolina, Charleston, SC, 3Department of Gastrointestinal and Laparoscopic Surgery, Med. Univ. of South Carolina, Charleston, SC Learning Outcome: Participants will be able to describe the nutrition-related outcomes that the outpatient RDN can impact in patients undergoing a Total Pancreatectomy with Auto-Islet Cell Transplantation. Total Pancreatectomy and Islet Auto-Transplantation (TP-IAT) is a surgical treatment for the debilitating pain of chronic pancreatitis (CP). There are no evidence-based nutrition guidelines or medical nutrition therapy (MNT) recommendations for this population. Patients with CP have alterations in gastrointestinal physiology and nutrient uptake and utilization. Literature reviews and clinical practice support the concept that patients undergoing TP-IAT benefit from perioperative intervention by a Registered DietitianNutritionist (RDN). The aim of this retrospective chart review was to assess the impact of dedicated perioperative, outpatient RDN intervention on the body weight (BW) status of patients that have undergone TP-IAT over the past 5 years (n¼126, 76% female). Change in BW was assessed before and at 6 months and 12 months after surgery. We compared a group that received dedicated outpatient perioperative RDN intervention (n¼27) to a random sample that did not receive outpatient RDN intervention (n¼ 22). On average, the total sample lost 7.5 10.5 kg at 12 months post-surgery. Over the entire 12-month period, patients exposed to outpatient RDN intervention were better able to maintain their BW compared to the no-RDN group (-2.36.4 vs -12.511.4 kg, p¼0.01 for the time-by-group interaction). After controlling for baseline BW and ferritin, the group exposed to outpatient RDN intervention, maintained BW at 12 months compared to the no-RDN group which lost 17.8 kg over 12 months (p¼0.008). RDNs in an outpatient setting dedicated to patients undergoing TPIAT can positively impact BW status when MNT is provided perioperatively.
Relationship between Subjective Global Assessment and Functional Independence Measurements among Acute Rehabilitation Patients Author(s): M.V. Betz, S. Peterson, D. Sowa; Food and Nutrition, Rush Univ. Med. Ctr., Chicago, IL Learning Outcome: Participants will be able to identify the role of nutrition in acute rehabilitation patient outcomes. Patients admitted to acute rehabilitation are often malnourished with low muscle mass and may have loss of functionality. The purpose of this quality improvement project was to determine if malnutrition is associated with Functional Independence Measurement (FIM) scores in acute inpatient rehabilitation patients. Mean age, BMI and percent malnourished derived from Subjective Global Assessment (SGA) were collected upon admission to acute inpatient rehabilitation. FIM scores, an ordinal scale of functional assessment, were collected from physical therapy (PT) and occupational therapy (OT) records upon admission and discharge. Mann-Whitney U tests were used to compare median FIM scores between subjects categorized as normal versus moderately/severely malnourished. Analysis included 97 patients with a mean age of 64 and BMI 29 kg/m2; 36% were malnourished. At admission, FIM scores were significantly higher in well-nourished patients compared to malnourished for PT (4.5 vs. 4.33, p¼0.012), OT (4.5 vs. 4.2, p¼0.05) and combined scores (4.55 vs. 4.19, p¼0.025). A similar trend was observed at discharge for PT (5.92 vs. 5.50, p¼0.003), OT (5.89 vs. 5.00, p<0.001) and combined PT/OT (5.93 vs. 5.13, p<0.001). More patients who were well-nourished reached independence level (45.5% vs. 11.4%). In addition, more patients who were malnourished were discharged to a skilled nursing facility or acute care (39% vs. 8%, p<0.001). Well-nourished patients performed better for both PT/OT at admission and discharge. Additionally, well-nourished patients were more likely to be discharged home. These results highlight the importance of nutrition in ability to complete activities of daily living in acute rehabilitation. Funding Disclosure: None
Funding Disclosure: None Identifying Attitudes of Healthcare Professionals toward Obese Individuals in a Hospital Setting
Impact of Ketogenic Diet Therapy on Carnitine Concentrations in Children with Intractable Epilepsy
Author(s): J. Turker, T. Crook, J. Phelps, R. Hakkak; Dietetics and Nutrition, Univ. of Arkansas for Med. Sci., Little Rock, AR
Author(s): J.E. Riebold1, C. Wray2, P. Haskell3, M. Gillingham1, D. Stadler1; Graduate Programs in Human Nutrition, Oregon Hlth. & Sci. Univ., Portland, OR, 2Pediatric Neurology, Oregon Hlth. & Sci. Univ., Portland, OR, 3 Oregon Hlth. & Sci. Univ., Portland, OR
Learning Outcome: Participants will be able to describe the attitudes of healthcare professionals toward obese patients in order to identify education and training needs for those caring for obese individuals. Obesity remains a national and global epidemic. Consequently, healthcare professionals are serving numerous obese patients every day. Studies indicate healthcare professionals hold negative attitudes toward obese patients, which could impact the quality of care they receive. Thus, the purpose of this study was to determine the attitudes of nursing professionals toward obese patients in order to identify education and training needs for staff working with these individuals. An online survey was completed by 228 nurses and nursing students at a medical center in Arkansas. The survey included the Fat Phobia Scale, a validated tool that assessed the participants’ negative attitudes toward obese individuals. One-way between groups analysis of variance (ANOVA) and independent-samples t-tests were used to determine if differences existed in fat phobia scores based on age, gender, practice area, years’ experience and body mass index (BMI) category of the participants. There were no significant differences in fat phobia scores based on age, gender, practice area or years’ experience; however, scores were significantly higher in participants with lower BMIs compared to those with higher BMIs (M¼ 3.5, SD¼ 0.46; M¼ 3.3, SD¼ 0.58, respectively), indicating that participants with lower BMIs had more negative feelings toward obese patients. These data indicate that healthcare professionals possess negative attitudes toward obese individuals, which could negatively impact the care they receive. Future research should focus on the education and training needs for nurses and other healthcare professionals caring for obese individuals in order to deliver the best possible care to this population. Funding Disclosure: None
1
Learning Outcome: Participants will be able to describe the impact of ketogenic diet therapy on carnitine concentrations in children with intractable epilepsy. The ketogenic diet (KD) effectively reduces seizure frequency in some children with intractable epilepsy (IE). Many centers routinely supplement with carnitine as an adjunct therapy during KD treatment in an attempt to optimize fatty acid oxidation for ketogenesis. However, there is insufficient evidence to support routine carnitine supplementation on a broad scale for these children. Therapeutic doses of carnitine may be cost-prohibitive and poorly tolerated, and these patients may maintain adequate carnitine status without intervention. We evaluated the effect of the classic KD (about 80-90% fat) on carnitine status in the absence of supplementation by assessing fasting plasma free and total carnitine concentrations in 14 children, 1 month-13 years of age, with IE before and during the first 12 months of treatment. Mean (SE) plasma free and total carnitine concentrations were 27.0 (2.3) and 43.5 (2.9) umol/L, respectively, before KD initiation. Relative to baseline, mean plasma total carnitine concentration increased 4.9 umol/L (95%CI: 1.9-7.9; p¼0.001) or 9.6% (95%CI: 4.0-16%) at 3 month intervals for the first 12 months of treatment. Mean free carnitine concentration did not vary significantly over time (p¼0.118). Despite these collective trends, six children had at least one free and three children had at least one total plasma carnitine concentration below established reference ranges during KD treatment. No overt signs of carnitine insufficiency (weakness, fatigue, or cardiomyopathy) were noted in any cases. These results suggest that the KD can impact plasma carnitine concentrations and that carnitine should be assessed and supplemented in some children during KD treatment. Funding Disclosure: Herbert D. and Nyelda Gemple Research Grant; Pediatric Nutrition Practice Group Research Award (Academy of Nutrition & Dietetics Foundation)
September 2015 Suppl 2—Abstracts Volume 115 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-27