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You Can Make a Difference When It Comes to Malnutrition

Julie Stefanski MEd, RDN, CSSD, LDN, CDE What if you had the potential to save your facility thousands of dollars? A growing body of evidence is demonstrating that significant revenue is lost when malnutrition goes undiagnosed and untreated. Up to 50% of hospitalized patients are at risk for or already have malnutrition, but only 7% actually receive a diagnosis and treatment.1,2  Malnutrition can significantly impact Medicare reimbursement and the case mix index for a facility. Our new interdisciplinary continuing education course Malnutrition Alert! How to Improve Patient Outcomes for nurses, dietitians, and physicians is designed to help you recognize the role that protein-calorie malnutrition plays in adult morbidity and mortality and to focus on the tasks required of the interprofessional team in preventing, diagnosing, and treating malnutrition. Written by Terese Scollard, MBA, RDN, LD, FAND, a leading expert in malnutrition, and a member of the Academy of Nutrition and Dietetics work group that in 2012 designed and released the Consensus Statement on malnutrition, this course provides the guidelines you need to tackle this important condition. Patients who are malnourished may not only have longer lengths of stay of up to 4 to 6 days, but hospital costs are on average twice as high for patients with malnutrition.2,3 Malnutrition can also lead to: An increased risk of adverse events and complications A 54% higher likelihood of hospital 30-day readmission4 Up to a 5 times more likely in-hospital death than a non-malnourished patient2 Prior to 2012 it was difficult to diagnose malnutrition in the past as there were no widely accepted characteristics that clinicians could use to classify this condition consistently throughout all care settings.  That all changed with the publication of the Academy of Nutrition and [...]

Do You Screen Your Nutrition Clients for Depression?

Julie Stefanski MEd, RDN, CSSD, LDN, CDE While the word “hangry” was only added to the Oxford English Dictionary in 2018, the connection between our food choices and our mood is clear to anyone who’s ever gotten testy when mealtime was delayed or turned to a comfort food for emotional support. October 11, 2018 is National Depression Screening Day Registered Dietitian Nutritionists are in a unique position to screen for mental health issues including depression that may not have been addressed appropriately. While clients may seek help regarding excessive weight gain or weight loss from a dietitian, those two nutrition issues are just one example of a possible side effect from an underlying psychological issue such as anxiety or depression. Jennifer Pelton, LCSW, a licensed social worker in York, PA points out that depression can take many forms depending on the persons' identified type of disorder according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. Pelton explained, “There are a few types of patterns an RD may identify in a client. One type could be someone who can’t perform daily activities due to extreme lack of energy and engagement in everyday jobs/roles. Another person may be over eating or using binge type behaviors in order to compensate for negative emotions, and is using eating as a form of coping.” Screen for Depression During the task of gathering medical and social history on a client, a dietitian may casually pick up on signs of depression, but there are also some tools to assist healthcare providers in screening for depression including PHQ-9 or Mood and feelings Questionnaire (MFQ) – short version. Dietitians should be on the lookout for other food related [...]

American Association of Diabetes Educators Meeting Wrap Up

For clinicians working with individuals living with diabetes, the challenges of keeping up with the latest changes in medications, insulin delivery devices and glucose monitoring devices can be daunting. OnCourse Learning staff spent a valuable few days speaking with attendees at the 2018 American Association of Diabetes Educators (AADE) Annual Meeting in Baltimore. Thanks to everyone that stopped by to talk about their challenges as diabetes educators.  Here are some of the most interesting highlights from the meeting for those who didn’t make it to Baltimore.  Meet DANA According to Lorena Drago, MS, RDN, CDN, CDE, a member of the editorial board for American Association of Diabetes Educator in Practice, DANA was one of the top buzzwords of the meeting. “The Diabetes Advanced Network Access, known as DANA, is an online central resource that allows AADE members to access the best available diabetes technology,” Drago said.  She visited the DANA lab to learn how to navigate the website and identify the most salient features AADE members can use to enhance and advance their practice. Hope Warshaw, MMSc, RD, CDE, BC-ADM, author of several best-selling consumer books published by the American Diabetes Association and diabetes expert agreed, “DANA is a one stop shop to learn about all of the latest diabetes technology and have a gateway to product websites to learn more.” According to Drago, once practitioners access DANA, there are eight different categories to choose from (see screenshot used with permission of DANA staff). Under each category, clinicians can find information about pens, meters, continuous glucose monitors, insulin pumps, infusion sets, insulin delivery devices, medication delivery devices and digital health platforms. “You can click on each product to obtain the technical specification and sponsor information,” [...]

If Clinical Nutrition Isn’t Your Niche

Part 2 of Should you Kick Your Career Off Clinical Style? Choosing an area of practice in dietetics after graduation is an exciting, but often conflicted time.  Thankfully dietitians have the option now of expanding their job prospects into areas of fitness, food service management, or grocery store based nutrition.  While these jobs may differ from a clinical setting, do new dietitians still need to start their career there? Here's part two of our two-part blog. (Click here to check out Part 1.) For some, becoming a dietitian is a stepping stone to expanding an already existing career.  Amy Gorin, MS, RDN, owner of Amy Gorin Nutrition in the New York City area, entered the dietetics field after a successful start in journalism.  According to Amy, “Although many of my nutrition professors suggested starting my nutrition career with a clinical focus, I decided not to go this route full-time—and you don’t have to, either! You can have a very successful and meaningful career with an alternate path. In addition to working with clients, I decided to jump right into nutrition communications—writing for media outlets and helping reporters with their nutrition-focused articles, consulting with brands and commodity boards, and offering media coaching services to other dietitians.” Jenna Gorham, RD, LN, owner of Jenna Gorham Nutrition Consulting feels that although the mentorship in a clinical setting was beneficial she knew that her strengths lay elsewhere.  Jenna explained, “I learned quite a bit in clinical, however I think you learn a lot in most entry level positions.  I now work in business and wellness and honestly don't use my clinical skillset much at all. For me, the main benefit of my clinical position was being able to work with [...]

Should You Kick Your Career Off Clinical Style?

It’s that time of the year when the job hunt for new dietitians is in full swing.  Although the bulk of available opportunities remains in the clinical setting, with ever expanding roles of dietitians in areas of media, culinary work, and retail dietetics, new grads have the option of skipping the traditional route of hospital-based practice after getting those well-earned RDN credentials. Is it necessary for new dietitians to start their careers in clinical nutrition? Check out part one of our two-part blog. The Case for Clinical For many new dietitians, work in a hospital or long-term care facility takes the number one spot on their list of desired job possibilities.  Sari Schlussel-Leeds, MS, RDN, CDN, a dietitian based in New York agreed, “Starting out in clinical nutrition is a must in my opinion. It’s a great opportunity to hone your knowledge and skills and the clinical information is so valuable to any future endeavors relating to medical clinical findings for those you serve. The people skills that are heightened when dealing with a vast population of differing socioeconomic strata will serve a dietitian not only professionally, but personally as well.” Zachari Breeding, MS, RDN, LDN, FAND, an executive chef who specifically entered the dietetics field to help him confidently assist his mother who was having some health issues, feels a clinical base is an absolute necessity.  “As a dietetic internship preceptor, I have always advised my mentees and students to begin their careers in the clinical setting. Medical Nutrition Therapy (MNT) is the basis of everything we do in dietetics, from culinary nutrition to community nutrition to public policy.” Zac added, “Regardless of their eventual professional goals, it is beneficial to the new RD [...]

Getting back to our roots: Nutritionists’ love of food

Dale Kline, MS, RD, LD As I write this, it is hot outside my home in southern Oregon. One hundred degrees to be exact, with smoke in the air from nearby forest fires. All I can think about is the bounty of food available locally, what this heat wave means to the crops and the impact on availability and prices. I should be thinking about and reading nutrition-related journals, newsletters and blogs to help me stay current on the latest nutrition-related news and studies. I also should be editing the nutrition-related courses to keep Nutrition Dimension customers up-to-date. Then, I got to thinking about how food is my job and how I love to cook. I bet many of you do, too. Most weekends you will find me at local farmers markets and produce stands where I go crazy buying so much produce that bowls full of vibrant-colored and nourishing veggies and fruit take up all of my available counter and refrigerator space. The fresh produce’s colors are amazing and so are the flavors. It is a joy to cook with such fresh ingredients and make delectable dishes. With these thoughts in mind, I decided to take a break from serious topics that have been the theme of past editions and instead focus on eating, which is the best part of what nutritionists help people do. My nickname for this edition of the magazine is “The Joy of Eating,” in celebration of food and why so many of us became dietitians and nutrition professionals in the first place. We love to eat and share our passion for food with others. It was hard to determine which articles to include in the magazine as [...]

By |September 9th, 2015|Categories: From the Editor|0 Comments

There’s so much for our profession to celebrate!

Dale Kline, MS, RD, LD Director Food, Nutrition and Dietetics, Nutrition Dimension Happy Registered Dietitian Nutritionist Day, and an even happier National Nutrition Month! Dietetics has been my life for almost 35 years. I am honored to be a dietitian. When I started my career there were limited options for dietitians – hospitals, nursing homes, WIC, government, academia and other institutions. There were dietitians who were “doing their own thing” but they were few and far between. In 1986, I started Nutrition Dimension with my husband and began the transformation from employee to entrepreneur, which is not as easy as it sounds. While being an entrepreneur I was not able to give up my other passion, clinical dietetics and nutrition support, which I kept on doing for 25 years. Filling in the cracks and thriving When I look at the profession, I am astounded at the transformation. No longer do we have to be in “traditional” jobs as there are many more opportunities for us now. Entrepreneurial dietitians abound in private practice, as authors, spokespersons, bloggers, business owners, etc. Dietitians are found working for major league sports teams, health insurance companies, health communication companies, corporations, fitness centers, newspapers, and radio and public relations companies. Some of those public relations companies are even owned by dietitians! I am so impressed with the ingenuity of RDNs who have created businesses or found a niche inside an institution. What we do is hard, and you are all to be commended. Most important of all, we are now looked upon as thought leaders, decision makers and professionals who influence consumers. Have you ever wondered why so many companies target their marketing to dietitians? The answer is simple. We control budgets [...]

New CMS rule gives dietitians order-writing privileges

Starting July 11, 2014, Registered Dietitian Nutritionists will be able to order diets in hospitals under Centers for Medicare and Medicaid Services (CMS) regulation. According to CMS, "the addition of ordering privileges enhances the ability that RDNs already have to provide timely, cost-effective, and evidence-based nutrition services as the recognized nutrition experts on a hospital interdisciplinary team." While this is a big win for dietitians, it is important to understand that the new CMS rule allows dietitians to write orders, but it is not a requirement for hospitals. What you need to know about the new regulation: CMS revised the proposed regulatory language from the draft. In this final rule CMS requires that all patient diets, ‘‘including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dietitians and nutrition professionals.’’ This regulation does not require hospitals and medical staff to grant or authorize specific privileges to specific practitioners, but only allows them the flexibility to do so if they choose, and only if State law allows for it. “Qualified dietitian” and “qualified nutrition professional” is the termed used by CMS in this regulation. This means an RD, RDN and “qualified” nutrition professional “…is to include all qualified dietitians and any other clinically qualified nutrition professionals, regardless of the modifying term (or lack thereof), as long as each qualified dietitian or clinically qualified nutrition professional meets the requirements of his or her respective State laws, regulations, or other appropriate professional standards.” RDN’s can be included as part of the medical staff. This is not a requirement, but something [...]

Our spring magazine and Medicare-compliant obesity counseling

I hope you all had a chance to see the Spring issue of the Nutrition Dimension magazine (either via the mail or the digital version) which is devoted to the topic of obesity. So many of us have been touched professionally and personally by this epidemic. How can we not when over 60% of the U.S. is either overweight or obese. We are inundated with stories and information about the obesity epidemic. News stories discuss a multitude of ways to prevent obesity, while TV shows and ads declare they have found the magic cure for obesity. In theory, losing weight should be simple: Decrease food intake and/or increase exercise output. In practice, however, losing weight is never simple. The reality is that 90% to 95% of people who lose weight do not keep it off. That is a dismal success rate. Yet more discussions and energy are devoted to helping people lose weight. Despite all the attention, more than 112,000 Americans die of obesity-related diseases each year and it contributes to four of the leading causes of death in the United States. The estimated total costs to society—including medical treatment, lost workdays because of obesity-related illness, and sales of diet products, foods and services—surpass $100 billion a year. In 2011, when Medicare began reimbursing primary care providers for intensive behavioral therapy for obesity, registered dietitians and registered dietitian nutritionists, were not among the providers allowed to be paid directly for Intensive Obesity Counseling. However they can be a part of a Medicare-compliant obesity program. To learn more about what comprises a Medicare-compliant obesity counseling program and how to increase the odds for success, take the time to read the continuing education course in the Nutrition [...]

Where have the sterols and stanols gone?

I need help. Today I was putting the final touches on the update of Functional Foods Part 2: Fermented Foods and Macronutrients (RD86). While I was double checking a list of foods with added stanols and sterols to make sure they are still available from the manufacturer, I found many in the list were not. So I searched the internet for a list of foods that have added sterols and stanols and to my disbelief, I could not find one. What I did find was information on the heart health benefits, which are many. When it came to the foods containing stanols and sterols, websites were vauge, saying you can find stanols and sterols added to margarines, oils, salad dressings, breads, yogurts but no specific food name nor a manufacturer. That got me wondering if the addition of stanols and sterols to food was just a fad or if food companies found they could not make money off of these products. I am not sure of the answer to that question. What do you think? Here is how you can help. If you know of a product that contains added sterols and stanols, please post the name of the food and the manufacturer below in the comments. I will take your input, compile the list and post it on for anyone looking for something to share with clients. Thanks for your help!

By |February 27th, 2014|Categories: From the Editor|Tags: , , |3 Comments