Research Involvement in a Group of Registered Dietitian Nutritionists Specializing in Ketogenic Diet Therapies for Epilepsy.

BACKGROUND: There is a growing need for studies on ketogenic diet (KD) therapies. Registered dietitian nutritionists (RDNs) should lead efforts to better understand the nutritional risks and benefits of the KD to inform evidence-based practices. OBJECTIVE: The purpose of this study was to explore participation in research among RDNs practicing in KD therapies for epilepsy and identify barriers to participation. DESIGN: This cross-sectional study collected professional experience, research involvement and output, and perceived barriers to conducting research. PARTICIPANTS/SETTING: This study surveyed 66 RDNs practicing in KD therapies for epilepsy. MAIN OUTCOME MEASURE: Research involvement was assessed using the Dietitian Research Involvement Survey score. Research output was reported as type and number of publications. Barriers to research included lack of time, resources, administrative support, training, and/or skill. STATISTICAL ANALYSES: Data were summarized using descriptive statistics, such as means and SDs, medians and interquartile ranges, counts and percentages, as appropriate. RESULTS: The median Dietitian Research Involvement Survey score was 31 out of 60 (range, 16 to 60). Thirty-two participants (48.5%) reported publishing or presenting data, and only 13.6% published an article on ketogenic diet therapies as a leading author. The main barriers to participating in research were insufficient time (83.3%), insufficient funding (81.8%), and priority of work (70.8%). Research involvement scores were not affected by lack of time and resources; however, scores were lower in RDNs reporting lack of interest, training, and skill in research. CONCLUSIONS: Although ketogenic RDNs participated in research, most were not leading projects or publications. To increase research involvement among RDNs, focus should include overcoming structural barriers and facilitating knowledge acquisition for those lower on the research continuum.

Use of a Mental Health Center Collaborative Care Team to Improve Diabetes Care and Outcomes for Patients With Psychosis.

OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness (compared with usual care) of a collaborative care model to treat community mental health center (CMHC) patients with psychosis and poorly controlled diabetes. METHODS: Stakeholder input was used to adapt a primary care-based collaborative care intervention for CMHC settings. Thirty-five adult CMHC clients with type II diabetes and hemoglobin A1c (HbA1c) >8% or blood pressure >140/90 were randomized to receive either collaborative care or usual care. Change in HbA1c was evaluated between baseline and three months. Paired t tests were used for within-group comparisons. RESULTS: After three months, intervention participants had a statistically significant mean decrease in HbA1c of 1.1% (p=.049). There was no significant change in HbA1c in the usual-care group. CONCLUSIONS: This pilot demonstrates the feasibility and acceptability of implementing collaborative care in CMHC settings and its preliminary effectiveness in improving glycemic control in a high-risk population.

Is spinal cord stimulation an effective treatment option for discogenic pain?

INTRODUCTION: In a prospective observational study conducted in an urban pain management center, we evaluated whether spinal cord stimulation (SCS) is effective in relieving discogenic pain of IDD origin. METHODS: Thirteen patients with intractable discogenic low back pain were enrolled. Four patients never underwent permanent implantation due to insurance denial, medical reasons or failed trial and served as a control group. Nine patients underwent SCS implantation (treatment group). All patients were followed for 12 months and assessed at each interval for pain (NRS), disability (ODI), and opioid use. RESULTS: Nine patients completed the SCS trial with > 50% pain relief. The pretrial NRS score was 7.8 ± 0.5 mm in treated patients vs. 6.5 ± 1.7 mm in control patients. At 3, 6 and 12 months, the NRS was reduced to 2.9 ± 0.7 mm, 1.7 ± 0.5 mm, and 2.9 ± 0.5 mm, respectively in treated patients. NRS was unchanged in the control patients (6.5 ± 1.9 mm). The ODI score prior to the SCS trial in treated patients was 53.1 ± 3.4% vs. 54.0 ± 20.5 in control patients. At 3, 6 and 12 months the ODI scores were 39.0 ± 8.0%, 38.7 ± 4.6%, and 41.1 ± 3.9%, respectively in the treated patients, and 48.5 ± 29.5 at 12 months in control patients. In 6 patients receiving opioids prior to the SCS trial, average consumption was reduced by 69% (P = 0.036) over 12 months of therapy as compared with a 54% increase in the control patients. SCS usage was stable over the 12-month study. CONCLUSIONS: The current study indicates that SCS may provide effective pain relief, improve disability, and reduce opioid usage in patients with discogenic pain.