Registered dietitians' roles in decision-making processes for PEG placement in the elderly.

PURPOSE: The role of registered dietitians (RDs) in decision-making for percutaneous endoscopic gastrostomy (PEG) placement was explored. The ethical climate in their workplace and the relationship between decision-making and the ethical climate were examined. METHODS: The survey included 67 RDs in complex continuing care and long-term care settings in Ontario. Descriptive statistics were used to describe roles, ethical climate, and professional characteristics. Pearson's and nonparametric correlations were used to examine relationships between roles, ethical climate, and professional characteristics. RESULTS: Among the respondents, 97% thought RDs had a role in decision-making processes. The majority of RDs were usually or always involved in two roles: identifying relevant nutrition issues (91.2%) and discussing feeding options and alternatives (80.7%). Dietitians' roles in decision-making processes were more extensive when their relationship with physicians was positive (r=0.321, P=0.016), they had adequate knowledge (r=0.465, P<0.001) and adequate skills (r=0.520, P<0.001), and they were more satisfied with their role (r=0.554, P<0.001). CONCLUSIONS: Registered dietitians performed a variety of roles in decision-making processes concerning PEG placement in the elderly. A positive working relationship with physicians, knowledge, skills, and role satisfaction significantly increase RDs' involvement with patients and families.

Making the Evidence-Based Case for Clinical Site Participation in Clinical Education: An ASAHP Clinical Education Committee Project.

BACKGROUND: Competition for clinical education sites is a known challenge for academic programs in allied health education with clinical sites reporting a variety of reasons for declining to participate in clinical education. In 2022, the Clinical Education Task Force (now Clinical Education Committee, CEC) of the Association of Schools Advancing Health Professions embarked on a project with the objective of creating an evidence-based resource that could be used by multiple professions to support the case for site participation in clinical education. METHODS: A literature search was conducted to identify contemporary published works on the positive impact of student clinical education placements on clinical sites. The publications were reviewed and four overarching themes were identified: students add value, productivity, preceptor perception, and patient perception. RESULTS: A one-page infographic was created to feature the four identified themes. A QR code embedded into the infographic links to the citations on which the themes are based. CONCLUSION: The one-page resource created by the CEC can be used to frame conversations about participation in clinical education, elevating the assertion of benefits from anecdotal to published-based claims. The resource is dynamic, as it can be updated continually as new information emerges and other information becomes outdated.

Health Professional Perspectives about the Future of Clinical Education: An ASAHP Clinical Education Committee Report.

In 2018, the Clinical Education Task Force (CETF) of ASAHP presented five recommendations to address clinical education needs. In 2019, the ASAHP Interprofessional Education Task Force (IPTF) established a regional summit for academic and industry constituents to improve health professional education and training. This article describes the steps taken to render a one-day St. Louis regional summit to receive stakeholder feedback on the nationally published recommendations for clinical education. The electronic survey was distributed to potential summit attendees about the CETF recommendations. Data categories captured included demographic details and questions about priorities, use, and engagement with the recommendations, and one open-ended question for each of the recommendations invited respondents to provide feedback. There were 349 respondents: 34% clinical preceptors/coordinators/directors, 31% academic program faculty, and 18% administrators. Common themes included the establishment of common goals between academic programs and healthcare organizations for partnership building, better recognition of the value of interprofessional collaborative practice, and technology as vital to the evolution of the healthcare system. Future directions should include regional summit meetings to address the implementation of the CETF recommendations relative to regional and localized challenges. Consensus-building efforts should address the diversity in responses relative to interprofessional collaborative efforts and clinical education research.

Survey of current job functions of renal dietitians.

OBJECTIVE: This cross-sectional study examined the current job functions of renal dietitians in relation to their demographic characteristics. SETTING AND PARTICIPANTS: Seven hundred and forty-seven dietitians of the Renal Dietitians Dietetic Practice Group of the American Dietetic Association and Council on Renal Nutrition of the National Kidney Foundation completed an electronic survey. Of 2566 surveys distributed, 29.1% (n=747) were returned and useable. MAIN OUTCOME MEASURE: Descriptive and inferential statistics were used. We performed chi(2) tests to identify relationships between reported job functions and demographic characteristics. Fisher's exact tests were used when greater than 20% of cells had an expected frequency of less than five. RESULTS: Dietitians' job functions were related to demographic characteristics. Dietitians with greater than 10 years of renal-dietitian experience were more likely to evaluate urea kinetic modeling frequently (chi(2)=32.95, P < .0005), or evaluate dialysis adequacy (chi(2)=24.16, P < .0005), than those with less renal-dietetics experience. Dietitians who worked in an outpatient facility were more likely to prescribe a renal diet frequently (chi(2)=13.39, P < .0005), recommend renal vitamins (chi(2)=9.81, P=.002), or evaluate interdialytic weight gain, or IDWG (chi(2)=32.24, P < .0005), versus those who did not work in an outpatient facility. CONCLUSIONS: This study documented the frequency of dietitians performing job functions related to renal dietetics. The results of this study document the variability in the role of renal dietitian, and suggest differing levels of practice within renal dietetics.

Effect of an oral health assessment education program on nurses' knowledge and patient care practices in skilled nursing facilities.

This pilot intervention study measured the impact of an oral health education intervention on nurses' knowledge and patient care practices in regard to oral assessments of institutionalized elders. Two 1-hour education sessions were completed over a 3-week period; a pretest and a posttest were administered immediately preceding the first session and immediately following the second session. Medical records were reviewed prior to and after the intervention to assess practices including completeness of oral health assessment and congruency with the Minimum Data Set 2.0 (MDS). Nine nurses attended the education intervention. Retrospectively, 176 records were reviewed preintervention and 80 postintervention. There was no significant change in knowledge from the pre- to posttest (p= .262). Completeness of all oral health assessment variables increased significantly (p= .001) as did the congruency of data between the nursing assessment (NA) and MDS assessments (p= .002). Providing nurses with education on oral health assessments in skilled nursing facilities has a positive impact on completeness of data and congruency between the NA and the MDS.

High School Students' College Outcomes in a Dual Enrollment Program, 1998-2015.

AIMS: This paper examines the college outcomes of dual-enrolled high school health science careers' students from 1998 to 2015. METHODS: For this retrospective descriptive evaluation of the program, the university requested from the National Student Clearinghouse (NSC) data on 6,831 students who had earned college credit through the Rutgers high school program. Descriptive statistics were used for analysis using Excel. RESULTS: Final dataset had 5,315 students, with 3,339 students who had been in college long enough to graduate. Of the 2,358 (71%) who had graduated from college, 62% (1,470) completed their associates or bachelor's degrees within 2 or 4 years, while an additional 25% (581) finished their respective degrees within 3 to 6 years. Students attending 2-year colleges had a 42% overall, on-time graduation rate, and students attending 4-year colleges had a 95% graduation rate. One or more health professions degrees were earned by 36% (862) of graduated students. DISCUSSION: College degree completion rates of these students are better than national performance and many students entered health careers. This paper adds to the literature on design and outcomes of dual high school/college enrollment at a time when states are expanding these partnerships.

Clinical Education in Transition: Recommendations and Strategies: A Report of the ASAHP Clinical Education Task Force.

The practice models, interdisciplinary team functions, intersecting competencies, economies, and settings of contemporary healthcare are all in flux, demanding that educators reconsider traditional health professions clinical education models and partnerships. The Association of Schools Advancing Health Professions (ASAHP) and Allied Health (AH) deans, collectively and individually, must determine the priorities and strategies to advance AH education. This paper offers five recommendations that stem from a review of literature pertaining to current changes in the healthcare sector and higher education that challenge the availability of AH clinical education. Vetted by AH educators and health system representatives, the recommendations subsume proactive strategies that target factors affecting learning in the clinical environment and aim to meet the needs of patients/clients, employers, students, and educators. The recommendations are: 1) Develop meaningful strategic partnerships with healthcare organizations; 2) Assess and integrate interprofessional competencies for efficient and effective interprofessional practice (IPP); 3) Incorporate effective use of healthcare technology into AH education and practice; 4) Advocate within and among healthcare systems, higher education leadership, accreditation and professional organizations, and governmental agencies to foster and support IPP competencies and effective cross-discipline referrals; 5) Drive excellence in clinical education through promotion of research and scholarly activity.

Loss-of-function mutations in MRAP2 are pathogenic in hyperphagic obesity with hyperglycemia and hypertension.

The G-protein-coupled receptor accessory protein MRAP2 is implicated in energy control in rodents, notably via the melanocortin-4 receptor1. Although some MRAP2 mutations have been described in people with obesity1-3, their functional consequences on adiposity remain elusive. Using large-scale sequencing of MRAP2 in 9,418 people, we identified 23 rare heterozygous variants associated with increased obesity risk in both adults and children. Functional assessment of each variant shows that loss-of-function MRAP2 variants are pathogenic for monogenic hyperphagic obesity, hyperglycemia and hypertension. This contrasts with other monogenic forms of obesity characterized by excessive hunger, including melanocortin-4 receptor deficiency, that present with low blood pressure and normal glucose tolerance4. The pleiotropic metabolic effect of loss-of-function mutations in MRAP2 might be due to the failure of different MRAP2-regulated G-protein-coupled receptors in various tissues including pancreatic islets.

Increased Hepatic PDGF-AA Signaling Mediates Liver Insulin Resistance in Obesity-Associated Type 2 Diabetes.

In type 2 diabetes (T2D), hepatic insulin resistance is strongly associated with nonalcoholic fatty liver disease (NAFLD). In this study, we hypothesized that the DNA methylome of livers from patients with T2D compared with livers of individuals with normal plasma glucose levels can unveil some mechanism of hepatic insulin resistance that could link to NAFLD. Using DNA methylome and transcriptome analyses of livers from obese individuals, we found that hypomethylation at a CpG site in PDGFA (encoding platelet-derived growth factor α) and PDGFA overexpression are both associated with increased T2D risk, hyperinsulinemia, increased insulin resistance, and increased steatohepatitis risk. Genetic risk score studies and human cell modeling pointed to a causative effect of high insulin levels on PDGFA CpG site hypomethylation, PDGFA overexpression, and increased PDGF-AA secretion from the liver. We found that PDGF-AA secretion further stimulates its own expression through protein kinase C activity and contributes to insulin resistance through decreased expression of insulin receptor substrate 1 and of insulin receptor. Importantly, hepatocyte insulin sensitivity can be restored by PDGF-AA-blocking antibodies, PDGF receptor inhibitors, and by metformin, opening therapeutic avenues. Therefore, in the liver of obese patients with T2D, the increased PDGF-AA signaling contributes to insulin resistance, opening new therapeutic avenues against T2D and possibly NAFLD.

Evaluation of diet quality and weight status of children from a low socioeconomic urban environment supports "at risk" classification.

This cross-sectional study evaluated diet quality and weight status in 248 randomly selected low-income urban children, aged 7 to 13 years, who were participating in a larger study on the effectiveness of multivitamin supplementation on school performance. Food frequency questionnaires were used to determine intake of total calories and food groups, selected micronutrients, and amount and percent of calories from sweets. Results were compared to age-appropriate recommendations of the Food Guide Pyramid and to the Dietary Reference Intakes. Height, weight, and ages obtained from current-year student health records were used to calculate body mass index (calculated as kg/m(2)) percentile for age. Of 193 participants with usable food frequencies and available weight, height, sex, and age, 22% (n=43) were at risk for overweight and 36% (n=69) were overweight. More than 75% of participants failed to meet recommended servings for grains, vegetables, dairy, and fruit groups, and mean intake of each of these food groups was significantly less than recommendations (P<0.001). Twenty-five percent or more of subjects did not meet Recommended Dietary Allowances for iron and folate. Mean intake of calcium was below the Adequate Intake for calcium and 76% of children 8 years old and younger and 93% of children 9 years old and older did not meet the Adequate Intake for calcium. Mean calorie intake was 1,723 kcal (standard deviation+/-924) and mean percent of calories from carbohydrate, protein, and fat was 57%, 13%, and 32%, respectively. No correlation was found between total calories, total dietary sugar, or percent of calories from sweets and body mass index. Results of this study suggest that these urban children may be "at risk," based on the high percentage who are overweight and have insufficient food group consumption and micronutrient intake.

Evaluation of high-school health science careers program impact on student retention and careers.

The purpose of this research was to longitudinally measure the impact of the University of Medicine and Dentistry of New Jersey-School of Health Related Professions high-school Health Science Careers program on student retention in health careers. Students (n = 1,218) who earned college credit in the program from 1996 to 2002 were surveyed. The response rate was 17% of the total and 21% of the deliverable surveys. Students were equally distributed between vocational, comprehensive, and academy-type schools. Ninety-seven percent of the students continued their education after high school, with 70% attending 4-year colleges. Forty-nine percent of those entering 2-year colleges and 57% of those entering 4-year colleges pursued health-related careers. Ninety-five percent perceived the Health Science Careers program as valuable. The findings suggest that the Health Science Careers program was helpful in guiding students toward health-related professions. The evaluation helped to understand the impact and to realize the positive and negative aspects of the program by the respondents.

The Future of Clinical Education: Opportunities and Challenges from Allied Health Deans' Perspective.

ISSUE: There is limited information and consensus on the future of clinical education and the key factors impacting allied health (AH) clinical training. AH deans identified both opportunities and challenges impacting clinical education based on a proposed educational model. METHODS: From July 2013 to March 2014, 61 deans whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi survey. Agreement on the relative importance of and the ability to impact the key factors was analyzed. Impact was evaluated for three groups: individual, collective, and both individual and collective deans. AH deans' responses were summarized and refined; individual items were accepted or rerated until agreement was achieved or study conclusion. RESULTS: Based on the deans' ratings of importance and impact, 159 key factors within 13 clinical education categories emerged as important for the future of clinical education. Agreement was achieved on 107 opportunities and 52 challenges. CONCLUSIONS: The Delphi technique generated new information where little existed specific to AH deans' perspectives on AH clinical education. This research supports the Key Factors Impacting Allied Health Clinical Education conceptual model proposed earlier and provides a foundation for AH deans to evaluate opportunities and challenges impacting AH clinical education and to design action plans based on this research.

The Future of Clinical Education: Using Futuristic Scenarios to Explore Allied Health Deans' Perspectives on Clinical Education.

ISSUE: There is limited information and consensus on the future of clinical education. The Delphi technique was selected to identify agreement among Association of Schools of Allied Health Professions' (ASAHP) allied health deans on the future (2018-2023) of allied health (AH) clinical education. METHODS: Sixty-one AH deans, 54.9% (61 of 111) of the ASAHP membership, expressed opinions about clinical education through a three-round Delphi study. In conjunction with a conceptual model, four futuristic scenarios were used to encourage deans' feedback on the key factors impacting the future of clinical education. RESULTS: The responses to the four scenarios showed ways the external environment influences which activities the deans recommend. The results presented, by individual scenario and in totality, provide relevant and timely information on the importance and transformation of AH clinical education and its future. DISCUSSION: Futuristic scenarios, in combination with the Delphi technique, generated information where little exists specific to AH deans' perspectives on AH clinical education. The results offer deans opportunities for future strategic improvements. CONCLUSION: The use of the futuristic scenarios was suitable for guiding deans' responses and reaching agreement on the future of AH clinical education. These contributions reflect the imminent conditions and healthcare environment identified in the various scenarios and provide additional insight on key factors impacting the future for AH clinical education.

Employers' Viewpoint on Clinical Education.

ISSUE: This qualitative study gathered the opinions of healthcare employers to better understand the importance, benefits, obstacles, and evolving issues related to allied health (AH) clinical education from the employers' perspective, with the goal to identify opportunities to strengthen and improve clinical-educational partnerships. METHOD: Member deans of the Association of Schools of Allied Health Professions (ASAHP) provided names and contact information of employers that routinely educate their students. Interviews were scheduled with employers who responded to Clinical Education Task Force (CETF) invitation. Twenty-one interviews were conducted by CETF members in early 2016 and analyzed utilizing qualitative software. OUTCOMES: Themes included benefits of working with students and hiring trainees, and obstacles of time and effort required to host students. A trend was noted in gaps between educational preparation and clinical performance. Recent changes highlighted increased technology and regulation, while anticipated changes included more focus on learning on site, longer clinical experiences, and payment for clinical education. CONCLUSION: Collaboration between educators and employers is essential to ensure that curriculum and outcomes match the needs of the field and effectively prepare students as entry-level clinicians.

The Future of Clinical Education: Using the Delphi Technique to Study Allied Health Deans' Perspectives on Definitions and Goals.

BACKGROUND: Allied health (AH) clinical education provides future health professionals with the experiences necessary to develop the healthcare competencies required for success in their individual fields. There is limited information and consensus on the purposes of clinical education, including its definition and goals, and its comprehensive role in AH clinical training. This study explored whether consensus could be achieved in the definition, goals, and factors impacting AH clinical education. METHODS: An expert panel consisting of 61 AH deans (54.9% of the population) whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi study. From July 2013 to March 2014, the deans expressed opinions about clinical education and its purposes. Responses were collected, summarized, and refined, and responses were accepted and re-rated until agreement was achieved or the study concluded. RESULTS: The hypothesis that AH deans would agree upon the definition and goals of clinical education was supported by this study's findings. Over 90% of deans "strongly agreed" or "agreed" on the definition of clinical education. A majority (90.2% to 92.7%) agreed with the goals. CONCLUSION: High agreement was achieved on the purposes of clinical education, resulting in a comprehensive definition of and goals for AH clinical education. The definition and goals of clinical education can be added in the healthcare literature and used in support of AH education.

DNA Damage and the Activation of the p53 Pathway Mediate Alterations in Metabolic and Secretory Functions of Adipocytes.

Activation of the p53 pathway in adipose tissue contributes to insulin resistance associated with obesity. However, the mechanisms of p53 activation and the effect on adipocyte functions are still elusive. Here we found a higher level of DNA oxidation and a reduction in telomere length in adipose tissue of mice fed a high-fat diet and an increase in DNA damage and activation of the p53 pathway in adipocytes. Interestingly, hallmarks of chronic DNA damage are visible at the onset of obesity. Furthermore, injection of lean mice with doxorubicin, a DNA damage-inducing drug, increased the expression of chemokines in adipose tissue and promoted its infiltration by proinflammatory macrophages and neutrophils together with adipocyte insulin resistance. In vitro, DNA damage in adipocytes increased the expression of chemokines and triggered the production of chemotactic factors for macrophages and neutrophils. Insulin signaling and effect on glucose uptake and Glut4 translocation were decreased, and lipolysis was increased. These events were prevented by p53 inhibition, whereas its activation by nutlin-3 reproduced the DNA damage-induced adverse effects. This study reveals that DNA damage in obese adipocytes could trigger p53-dependent signals involved in alteration of adipocyte metabolism and secretory function leading to adipose tissue inflammation, adipocyte dysfunction, and insulin resistance.

Functions performed by level of practice of registered dietitian members of the diabetes care and education dietetic practice group.

The purpose of this study was to examine current professional practices of registered dietitians (RDs) in the Diabetes Care and Education dietetic practice group (DPG), analyzed by levels of practice: entry-level, specialty-practice, or advanced-level. The results of the Diabetes Care and Education DPG 2002-2003 membership survey were used for this study. The study was limited to RD members of the Diabetes Care and Education DPG who completed the membership survey in its entirety. Frequency distributions, chi2, Fisher exact test, and cluster analysis were performed with a prior alpha set at .10. Sixty-one (5.0%) RDs were functioning as an entry-level practitioner, 851 (69.1%) were functioning as a specialty-practice practitioner, and 320 (25.1%) as an advanced-level practitioner. Significantly more advanced-level practitioners were performing more tasks compared with entry-level practitioners. Entry-level RDs performed a mean of 2.4 functions, specialty-practice practitioners performed 7.7, and advanced-level practitioners performed 11.6 functions. The results of this survey further delineated that RDs function at various levels of practice and that credentials for RDs increased as level of practice advanced.

Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding.

It is the position of the American Dietetic Association that the development of clinical and ethical criteria for the nutrition and hydration of persons through the life span should be established by members of the health care team. Registered dietitians should work collaboratively to make nutrition, hydration, and feeding recommendations in individual cases. Registered dietitians have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When patients choose to forgo artificial nutrition and hydration, or when patients lack decision-making capacity, and others must decide whether or not to provide artificial nutrition and hydration, the registered dietitian has an active and responsible professional role in the ethical deliberation around that decision. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The registered dietitian's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration.