Factors That Influence Dietetic Interns\u27 Dietary Practices

Background: The dietetic internship is a rigorous supervised practice experience that all future registered dietitians must complete. Research suggests that environmental and social factors may affect dietary choices. No studies have been done to evaluate if the rigorous internship experience affects interns’ dietary practices. Objective: The objective of this focus group research study was to gather opinions from various dietetic interns to understand what factors of the internship experience, if any, affected interns’ dietary habits and preferences. It was hypothesized that environmental and social factors from the dietetic internship would impact interns’ dietary habits. Design: Qualitative data was collected via seven virtual focus group sessions in which trained moderators asked a series of controlled questions to ensure consistency among the group sessions. Participants/Setting: Candidates were recruited across the United States through an email distributed by dietetic internship directors. Participants (n=42) were currently completing or had completed their dietetic internship within six months (40% attrition rate). Interns attended one of seven virtual focus groups on Zoom to accommodate geographical location. Each focus group contained at least five participants. Analysis: Transcripts were separately coded by two to three trained researchers using methods outlined by Krueger and Casey to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Results: Elements related to the dietetic internship were observed to influence dietary choices of participants. The main factors affecting interns’ dietary choices were finances, access/availability (e.g. access to a refrigerator, microwave, etc.), mental load] , and time. A minor theme identified was social influence, including the influence of preceptors. Conclusions: Finances, access/availability, mental load, time, and social influences impacted interns’ diets. Dietetic programs and preceptors should explore ways to minimize the potential negative impacts of these factors on interns’ dietary habits

Factors Influencing Dietetic Interns\u27 Dietary Habits During Supervised Practice

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants’ dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns’ awareness and minimize the potential negative impacts of these factors on interns’ dietary habits to improve their overall internship experience

Regulation of Hepatic Triacylglycerol Metabolism by CGI-58 Does Not Require ATGL Co-activation

SummaryAdipose triglyceride lipase (ATGL) and comparative gene identification 58 (CGI-58) are critical regulators of triacylglycerol (TAG) turnover. CGI-58 is thought to regulate TAG mobilization by stimulating the enzymatic activity of ATGL. However, it is not known whether this coactivation function of CGI-58 occurs in vivo. Moreover, the phenotype of human CGI-58 mutations suggests ATGL-independent functions. Through direct comparison of mice with single or double deficiency of CGI-58 and ATGL, we show here that CGI-58 knockdown causes hepatic steatosis in both the presence and absence of ATGL. CGI-58 also regulates hepatic diacylglycerol (DAG) and inflammation in an ATGL-independent manner. Interestingly, ATGL deficiency, but not CGI-58 deficiency, results in suppression of the hepatic and adipose de novo lipogenic program. Collectively, these findings show that CGI-58 regulates hepatic neutral lipid storage and inflammation in the genetic absence of ATGL, demonstrating that mechanisms driving TAG lipolysis in hepatocytes differ significantly from those in adipocytes

Clinical implications of mucosal remodeling from chronic rhinosinusitis

Background: Prognostic implications of mucosal remodelling in chronic rhinosinusitis CRS) remain unclear. Remodelling of respiratory mucosa in asthma is associated with greater medication use and decreased function. This study investigates the implications of mucosal remodelling on long term clinical outcomes in patients with CRS. Methods: A case control study of adult patients with CRS undergoing endoscopic sinus surgery ESS) was performed. Mucosal remodelling was defined by squamous metaplasia, subepithelial fibrosis and/or basement membrane thickening. The presence of remodelling changes were assessed relative to clinical and treatment outcomes at a minimum of twelve months postoperatively. Clinical outcomes were assessed at baseline and 12 months using a Nasal Symptom Score NSS) and Sino-Nasal Outcome Test (SNOT-22).Treatment outcomes were assessed by oral corticosteroid usage (burst/ continuous), topical corticosteroid irrigation frequency and further surgical intervention. Results: 112 patients 48.9 ± 14.9 years, 49.1% female) were assessed. Significant improvements where seen for the entire population, in both NSS (2.62 ± 1.06 to 1.30 ± 1.08, p < 0.001) and SNOT-22 2.03 ± 0.96 to 1.03 ± 0.78, p < 0.001). Patients with remodelling n = 89) were younger (47 ± 14.7 v 54.7 ± 13.5 yrs, p = 0.03) but had similar symptom scores. Remodelling was seen in CRSwNP 86.0%) and eosinophilic CRS (86.9%). Symptom improvement at 12 months was similar between remodelled and non-remodelled groups NSS Δ1.28 ± 1.22 v Δ1.03 ± 1.34, p = 0.403), SNOT-22 Δ1.00 ± 0.92 v Δ0.66 ± 0.98, p = 0.129)) however, patients with remodelling had greater corticosteroid irrigation frequency (52.9% v 5.7% daily use, Kendall’s tau-b p = 0.004) and trended towards more oral steroid usage and further surgical intervention. Conclusions: Established mucosal remodelling predicts a greater reliance on topical therapies to reach similar clinical endpoints as those without remodelling.2 page(s

Costal cartilage lateral crural strut graft vs cephalic crural turn-in for correction of external valve dysfunction

Importance: External nasal valve dysfunction (EVD) is a common cause of nasal obstruction. Objective: To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD. Design, setting and participants: In this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty. Main outcomes and measures: Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. Results: Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02). Conclusions and relevance: Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD.6 page(s

Factors Influencing Dietetic Interns&rsquo; Dietary Habits during Supervised Practice

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants&rsquo; dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns&rsquo; awareness and minimize the potential negative impacts of these factors on interns&rsquo; dietary habits to improve their overall internship experience

Evaluating training for a simulated team in complex whole procedure simulations in the endovascular suite

Introduction: Simulators supporting the development of technical skills for complex procedures are gaining prominence. Safe performance of complex procedures requires effective team interactions. Our research group creates ‘whole’ procedure simulations to produce the psychological fidelity of clinical settings. Recruitment of real interventional team (IT) members has proved challenging. Actors as a simulated team are expensive. We hypothesised that medical students and trainees in a vascular unit could authentically portray members of the endovascular suite for carotid stenting. Methods: This paper describes the evaluation of a training programme for a simulated IT. Participants rated the extent to which programmes objectives were met and realism of simulations. Researchers’ field notes provided insight into strengths and weaknesses of the programme. Results: Seven members from the vascular unit undertook training. Learning objectives were largely met. Nineteen simulations with 13 interventionalists were performed. Realism levels were at least moderate. Simulated IT members reported increased understanding of teamwork and roles in the endovascular suite. Discussion: A simulated IT proved feasible. Authentic psychological fidelity complemented the physical fidelity of the simulated suite. Although there were areas for development in training, this approach might contribute considerably to interventionalist training and increase knowledge and skills of vascular trainees and medical students