New resources added to my clinical nutrition practice library

 During the past couple of weeks of Googling, tweeting, & blogging, I've discovered new-to-me resources -- some through focused searching, others by stumbling upon them while looking for something else. Here are the keepers I've bookmarked to help me with reading the literature, assessing and planning care, educating interns and answering patients' and families' questions. Perhaps they will help you, too, whether you are providing, receiving or learning about health care.

• Evaluating Health Information (Medline Plus)

• Understanding Medical Research

• Evaluating Medical Research Findings and Clinical Trials

• Medical Biochemistry, particularly the Biochemistry of Vitamins

• Evaluation of Laboratory Data in Nutrition Assessment (ppt)

• Long-Term Enteral Tube Feedings: Ethical Guidelines for Health Care Professionals (MS Word) {Source}

• Patient and Family Guidelines - Making Decisions About Long-Term Tube Feeding (MS Word) {Source}

I've saved all the delicious, food-oriented finds for a separate entry -- a treat for me as much as you because those posts are so much fun to write.

"Longing for Recognition" -- A new and different book on dietetics

This morning while skimming "Gerry's List", I read about a new book on dietetic education and practice -- I admit the fascinating title made me look closely:

Longing for Recognition
The joys, complexities, and contradictions of practicing dietetics

by Jacqueline Rochelle Gingras, PhD, RD

Published by Raw Nerve Books,  York, UK, 1st February 2009,
ISBN 978-0955358654

$25 CAD, $22 USD

Longing for Recognition offers a radical new way of understanding nutritional health practices. In contemporary food culture, the work of dietitians has accrued new and urgent meaning, and Longing for Recognition is addressed to that group of practitioners. The author, herself a dietitian, crafts an autoethnographic fiction that presents a critical and thought-provoking argument for a more self-reflexive, relational, and embodied profession. Her compelling narrative draws the reader into its timely call for rethinking what counts as knowledge in dietetic education. Longing for Recognition will be invaluable for dietitians and other health care professionals who wish to enhance their practice as one that considers first and foremost what it means to be human.

Reviewers' Comments

Longing for Recognition is a landmark nutritional and educational text and a whole new way of mapping the terrain. The book is an urgent, eloquent and compelling journey towards tomorrow's dietetics, and Gingras draws us out from 'safe places' to hold vulnerability up to the light. Engagingly narrated through both a personal and a conceptual lens, her book is a telling and necessary exposition of her discoveries. Lucy Aphramor, RD, Health Researcher, Coventry University, UK

Professionals too rarely address the limits of their training or the strong emotions produced by the dilemmas they face in their work. This richly layered story - compelling in its attention to real people with complex lives at work and at home - treats nutrition educators as accomplished but also fully human practitioners, who struggle to reconcile the realities of everyday practice with their desires to make a better world, for themselves and others. Marjorie DeVault, PhD, Professor of Sociology, Syracuse University, USA

About the author
Jacqueline Gingras, PhD, RD is an Assistant Professor at Ryerson University's School of Nutrition, Toronto, ON. She conducts research into dietetic education and practice. Previous work has appeared in publications as diverse as Feminist Media Studies; Food, Culture & Society; and Educational Insights.

Source of book information.  Author's web page.

I very much like the book's subtitle: it aptly describes my (and maybe your) experiences & emotions when getting and giving nutrition knowledge in a "real-world" setting. Sometimes the process and interactions are joyful: more often, they are complex, and contradictory, with elements of controversy & uncertainty added to the mix. I think Dr. Gingras is correct: a reflective, fully human, honest orientation will enhance our practice & profession.

Congratulations, Dr. Gingras, on this thoughtful book and thank you for it.

Nutrition articles in "Nature Clinical Practice Neurology" (January & February 2009)

Because I work on a Neuroscience unit, I periodically scan the online neurology and neurosurgery literature for nutrition content. Recently I found these free, full-text articles in Nature Clinical Practice Neurology:

Click on image for full size and source

• Food for thought    HTML   PDF

This editorial reminds us nutritional supplements "have real pharmacological effects, not all of which are desirable."  True, too much of a good thing (a nutrient) can be bad thing (work against other medications). I appreciate the editor's closing statement: "It is, of course, understandable that patients will want to pursue all available options for the treatment of their condition, but they need to be provided with realistic expectations of the benefits, as well as being informed of any potential risks."

Application to practice: Be empathetic to people's needs but truthful about what the best evidence tells us.

• The ketogenic diet, four score and seven years later   HTML  PDF   

This commentary discusses the findings of randomized controlled trials.

Application to practice: "The ketogenic diet should be considered in the treatment of children with refractory epilepsy, and not only as a last resort.

• Polyunsaturated fatty acids and their potential therapeutic role in multiple sclerosis  HTML  PDF 

Key points from this article:

■ Epidemiological studies demonstrate an association between saturated fat intake and the incidence of multiple sclerosis (MS)
■ In vivo studies demonstrate that polyunsaturated fatty acids (PUFAs) can exert anti-inflammatory effects through multiple, complex mechanisms
■ Controlled and noncontrolled trials have produced mixed results regarding the efficacy of PUFAs in MS; however, these trials have several limitations that could partially explain the lack of a treatment effect
■ Despite the lack of definitive evidence that PUFAs can be beneficial in MS, the anti-inflammatory potential of these agents is intriguing
■ The potential role of PUFAs as a treatment for MS should be further explored in proof-of-concept studies that use MRI-based outcome measures

Application to practice: Because these researchers believe more, better designed research should be conducted, I cannot discourage MS patients from modifying their diets or hoping some day we may find a nutrient or food that may make a difference in their disease progression, symptom management and/or quality of life; I would support them in making the healthiest fat choices by providing education.

Treating the Whole Patient

Touch by chrisevans on Flickr. Used under a Creative Commons Licence.My favourite resource of the week is about the art of medicine. No clinical trials or statistics involved. A patient's family member handed me a newspaper clipping (see below) during our low tech, highly connected encounter. In other words, we had a face-to-face, heart-to-heart talk that cannot be replaced by 140-character exchanges.

Treating the Whole Patient    Web page    PDF

Tweeter's Digest

 

I'm torn between micro-blogging on Twitter & "long form" blogging on Greens & Berries. (If you aren't familiar with Twitter, you may want to read this overview.)  Because each Twitter message or "tweet" consists of no more than 140 characters (spaces included), I'm forced to be highly selective and concise about what I share. I'm still experimenting but I think, used wisely, Twitter can be an efficient, interactive learning and communication tool that spreads the wealth of knowledge far and wide.

Here are several links I shared via Twitter during the past few days:

• A Low-Fat Vegan Diet Elicits Greater Macronutrient Changes, but Is Comparable in Adherence and Acceptability, Compared with a More Conventional Diabetes Diet among Individuals with Type 2 Diabetes. Here are links to the study's abstract and a dietitian's commentary in the Globe & Mail.

• Gramene Species. If doing research on grasses or just simply curious about cereal grains, this site, which goes beyond genomics, is worth checking out.

• The International Framework for Food Description. While looking for the online Canadian Nutrient File, I serendipitously found this site that includes helpful compilations {1} {2} of food composition data.

• In the Service of Life. Wisdom from Dr. Rachel Naomi Remen who explains the important differences among serving, helping and fixing.

• Food for Thought. An editorial on supplements and neurological disease, published in the online Nature Clinical Practice Neurology.

I've also discovered food and nutrition resources through other Twitter users' updates -- but I'll leave these for another day. You see, I've had to set an Internet curfew. (Many thanks to Sophie who pointed out the blog post that will help me do this.)