Methodology for altering omega-3 EPA+DHA and omega-6 linoleic acid as controlled variables in a dietary trial.

BACKGROUND & AIMS: Increasing dietary intake of n-3 EPA+DHA and lowering dietary n-6 LA is under investigation as a therapeutic diet for improving chronic pain syndromes as well as other health outcomes. Herein we describe the diet methodology used to modulate intake of n-3 and n-6 PUFA in a free living migraine headache population and report on nutrient intake, BMI and diet acceptability achieved at week 16 of the intensive diet intervention and week 22 follow-up time-point. METHODS: A total of 178 participants were randomized and began one of three diet interventions: 1) a high n-3 PUFA, average n-6 PUFA (H3) diet targeting 1500 mg EPA+DHA/day and 7% of energy (en%) from n-6 linoleic acid (LA), 2) a high-n-3 PUFA, low-n-6 PUFA (H3L6) targeting 1500 mg EPA+DHA/day and <1.8 en% n-6 LA or 3) a Control diet with typical American intakes of both EPA+DHA (<150 mg/day) and 7 en% from n-6 LA. Methods used to achieve diet change to week 16 include diet education, diet counseling, supply of specially prepared foods, self-monitoring and access to online diet materials. Only study oils and website materials were provided for the follow-up week 16 to week 22 periods. Diet adherence was assessed by multiple 24 h recalls administered throughout the trial. Diet acceptability was assessed in a subset of participants at 4 time points by questionnaire. RESULTS: At week 16 H3 and H3L6 diet groups significantly increased median n-3 EPA+DHA intake from 48 mg/2000 kcals at baseline to 1484 mg/2000 kcals (p < 0.0001) and from 44 mg/2000 kcals to 1341 mg/2000 kcals (p < 0.0001), respectively. In the Control group, EPA+DHA intake remained below the typical American intake with baseline median at 60 mg/2000 kcals and 80 mg/2000 kcals (p = 0.6) at week 16. As desired, LA intake was maintained in the H3 and Control group with baseline median of 6.5 en% to 7.1 en% (p = 0.4) at week 16 and from 6.5 en% to 6.8 en% (p = 1.0) at week 16, respectively. In the H3L6 group, n-6 LA decreased from 6.3 en% at baseline to 3.2 en% (p < 0.0001) at week 16. There were no significant changes in BMI or diet acceptability throughout the trial or between diet groups. CONCLUSIONS: We find this diet method to be acceptable to research participants and successful in altering dietary n-3 EPA+DHA with and without concurrent decreases in n-6 LA. If n-6 LA of less than 3 en% is desired, additional techniques to limit LA may need to be employed.

Acceptance of physician assistants and nurse practitioners in trauma centers.

OBJECTIVE: Census data published by professional organizations indicate an upward trend in the number of physician assistants (PAs) working in many specialty fields, including the subspecialty of trauma surgery. As the role of hospital-based PAs and nurse practitioners (NPs) continues to evolve, greater understanding of these roles will help identify future employment trends for these professions. The purpose of this study is to determine the prevalence of PAs and NPs in US trauma centers, to document their roles, and to identify their potential future utilization by trauma centers. METHODS: A survey was mailed to 464 directors of major trauma centers in the United States. The survey was designed to evaluate trauma centers' utilization of PAs/NPs. Respondents were asked to identify specific daily tasks of PAs/NPs and to indicate potential for their future utilization. RESULTS: Two hundred forty-six (246) of 464 surveys were returned, for a response rate of 53%. Approximately one-third of reporting major trauma centers reported utilizing PAs/NPs. More American College of Surgeons (ACS)-verified trauma facilities utilized PAs/NPs than did nonverified facilities; and Level I trauma centers used significantly more PAs/NPs than did Level II trauma centers. Nineteen percent (19%) of respondents who did not currently utilize PAs/NPs indicated that they intended to do so in the future. The majority of facilities utilized PAs/NPs to assist with trauma resuscitation and in performing traditional tasks, including obtaining and dictating histories and physical findings, participating in rounds on the general medical floor, and dictating discharge summaries. Fewer than half of reporting facilities indicated that PAs/NPs performed more invasive procedures, such as inserting arterial lines, central lines, chest tubes, and intracranial pressure monitors. CONCLUSIONS: PAs and NPs are increasingly utilized as clinicians in the surgical subspecialty of trauma. In most trauma centers, PAs/NPs are utilized to complete the traditional duties of a surgical PA/NP, with fewer performing invasive procedures. Finally, 19% of responding trauma centers who do not currently utilize PAs/NPs state that they intend to in the future, indicating the potential for continued job growth for PAs/NPs in trauma care. This evaluation of the utilization of PAs/NPs in direct care to trauma patients indicates acceptance of PAs/NPs in trauma staffing models.