The Use of Patient Simulations to Teach and Assess Clinical Competencies in Colleges of Podiatric Medicine: A Survey of US Podiatric Medical Schools.

Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric Medical Examiners implemented the Clinical Skills Patient Encounter, an examination using standardized patients. Similar clinical skills examinations already existed as part of medical and osteopathic licensure examinations. The purpose of this study was to assess the use of simulation-based education in the nine colleges of podiatric medicine in the United States to inform podiatric clinical faculty and other stakeholders about current trends within the podiatric education system. In 2019, the Clinical Skills Patient Encounter committee of the National Board of Podiatric Medical Examiners developed a survey and contacted each podiatric school to voluntarily participate. The mailed survey instrument gathered information on patient simulation modalities, years used, clinical content application, simulation program administration, facilities and equipment available, and the role of simulation educators. All nine schools participated anonymously. The survey showed that simulation modalities were used in all of the schools during the first 3 years, although there was considerable variance in their use.

Management of Hyperphosphatemia in End-Stage Renal Disease: A New Paradigm.

Bone and mineral metabolism becomes dysregulated with progression of chronic kidney disease (CKD), and increasing levels of parathyroid hormone serve as an adaptive response to maintain normal phosphorus and calcium levels. In end-stage renal disease, this response becomes maladaptive and high levels of phosphorus may occur. We summarize strategies to control hyperphosphatemia based on a systematic literature review of clinical trial and real-world observational data on phosphorus control in hemodialysis patients with CKD-mineral bone disorder (CKD-MBD). These studies suggest that current management options (diet and lifestyle changes; regular dialysis treatment; and use of phosphate binders, vitamin D, calcimimetics) have their own benefits and limitations with variable clinical outcomes. A more integrated approach to phosphorus control in dialysis patients may be necessary, incorporating measurement of multiple biomarkers of CKD-MBD pathophysiology (calcium, phosphorus, and parathyroid hormone) and correlation between diet adjustments and CKD-MBD drugs, which may facilitate improved patient management.

Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist.

Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.

Selected nutrition practices of women on hemodialysis and peritoneal dialysis: observations from the NKF-CRN Second National Research Question Collaborative Study.

OBJECTIVE: The objective of this study was to report selected nutrition behavior practices (type and amount of fat, fiber, and beverage intake) collected by self-administered validated food frequency questionnaires (FFQs) as part of the 1998 to 1999 NKF-CRN Second National Research Question Collaborative Study Group. DESIGN AND METHODS: This study was conducted on a prospective randomized cohort of 264 adult women 18 years of age or older that were on hemodialysis (HD) or peritoneal dialysis for more than 3 months and were receiving treatment in 116 U.S. dialysis centers. These women completed the same self-administered validated FFQ used in the Women's Health Initiative Dietary Modification Trial. MAIN OUTCOME MEASURES: Main outcome measures included tabulated FFQ data and selected nutrition practices using descriptive statistics (frequency, percentage). Associations with selected demographic and geographic region variables were examined, and nutrition practice differences by age, registered dietitian full-time equivalents, years on dialysis, and body mass index (BMI) categories were investigated using analyses of variance. RESULTS: Demographics (mean ± standard deviation) were age (56.1 ± 15.3 years), years on dialysis (5.3 ± 4.6 years), and race/ethnicity (62% White, 30% Black) with 86% on HD. The nutrition behavior of taking the skin off of chicken was more prevalent in White women (P < .0005) whereas adding fat to cooking was higher in Black women (P < .0005). Differences in other selected nutrition practices were also observed. CONCLUSIONS: Low-fat intake behaviors were reported in 30% to 50% of the sample; fiber intake was minimal (mean 10 g/day). Self-administered FFQs may have limitations in calculating actual intake, but this is the first report of dietary patterns specifically in women undergoing maintenance dialysis from 1998 to 1999. These data could be used to increase fruit and vegetable intake within renal diet parameters and support awareness of healthier food choices.

Nutrition interventions to address cardiovascular outcomes in chronic kidney disease.

The high mortality in chronic kidney disease has been linked to cardiovascular risk and these patients are considered at high risk. Dietary intervention can directly address nutritional risk factors in lipid management, calcium-phorphorus balance, and body composition to reduce risk of cardiovascular disease. Nutrient intake can also indirectly address less overt risks of dental health, nutritional supplements, and compliance issues.

Medical nutrition therapy in chronic kidney failure: integrating clinical practice guidelines.

This review updates earlier published recommendations and integrates current clinical practice guidelines for nutritional care in chronic kidney disease as recommended by the National Kidney Foundation Kidney Dialysis Outcome Quality Initiative (K/DOQI). The scope covers chronic kidney disease in adults prior to kidney failure (Stages 1-4), chronic kidney failure with hemodialysis or peritoneal dialysis replacement therapy (Stage 5), and management after kidney transplantation. Multiple diet parameters are necessary to provide optimal nutritional health, including monitoring of calories, protein, sodium, fluid, potassium, calcium, and phosphorus, as well as other individualized nutrients. Emphasis is placed on continuity of care within changing kidney function and treatment modality status. The rising incidence of chronic kidney disease will increase the probability of the non-renal specialist dietetics professional delivering care to this patient population.