Online CPD for a dietitian

A space to capture my thoughts/experience I'd like to remember from my clinical practice, interesting articles... anything really! All anonymised and views are totally my own. #LazyCPDPortfolio

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Old post that didn’t upload!

BBC has an article/video on etiquette for eating at your desk. Dietitians know it’s best to get away from your desk to eat. Either for physical or mental health reasons!

Alison Clark says it well!

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24/2/18 Allergy webinar with BDA Yorkshire. 4 topics in a morning! 1) Dietitians and allergy UK - Kate Roberts [email protected] 2) Paeds allergies, specifically CMPA - Lydia Collins 3) Adult allergy management - best one! Dr Isabel Skypala (London based) 4) Nutritional deficiencies in multiple allergy (multi exclusion diets), focus on iodine in paeds but likely relevant adults. Rachel Woods (Manchesters Paeds Allergy Lead)

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lymphoma association day programme

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Proud to have spoken at #LymphomaAssociation day in Lancaster Sat 19th November 2016. Great programme and speakers. Great organisation team too. I got so much out of it and hope others did too.

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Haematology grand round - 26/5/16 Main points as above!

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'Detecting Bacteria' and IBD

Faecally bacterium prausnizi has an anti-inflammatory molecule called Mam (micro antinflammatory molecule), this molecule can be attached to an ecoli cell. This ecoli has not yet been able to be cultured into probiotics but hopefully will be able to, then when the ecoli detects inflammation it releases more Mam which can help to reduce inflammation and reduce or stop flare ups. Quick update from my friend who wrote a proposal poster at uni for her masters in bioengineering and biotechnology! When I read more and understand more I'll update this.

[askadietitianltd-blog]

More and more links with vit D and cancer Especially colorectal cancer http://m.gut.bmj.com/content/early/2016/04/06/gutjnl-2015-310977.abstract Higher VDR expression = better clinical outcomes for colorectal cancer BUT n=687? VDR expression higher due to previously high intakes of vit D? Or other reasons? http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037662#abstract Low 25-OH D and greater cancer incidence -BUT did they account for lower fibre diets or higher red meat and processed foods? Or alcohol -Scottish diets known for being poorer quality (sorry!) Conclusion..... To discuss with my consultants regarding patient implementation My opinion.... Yes vitamin D is fat soluble and so excess intake not necessarily recommended due to storage ability and potential later related-toxicities HOWEVER Lower prevalence of cancer if higher vit D, also better outcome if more Vit D receptors in your tissue sample during treatment shows a link to me - strength of link to be determined if data replicates across more studies Those with higher gut cancer risk post radiotherapy should all hair vitamin D? What dose? INTERESTING CLINICAL RESEARCH PROPOSAL!! Changes to my practice -in latent effects clinic, get vit d test but recommend supplement (10mcg or 400iu) regardless. -may supplement in chemo/rad colo pts, DT to advise me!

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Really interesting allergy advert. Weird and wonderful allergies!

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High Vitamin D Foods

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Quick easy reminder for religious or cultural diet needs!

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LINKING OBESITY & MENTAL HEALTH - the 5 Ps can be useful to identify factors hindering the the patient in making behavioural changes - using the 5ps is more holistic and more likely to help the patient by addressing or at least considering contributing factors - the eating disorder examination interview can help assess for binge eating disorder

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New BDA app. Pricey! Let's see how it works...

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Coeliac disease vs potential coeliac value non coeliac gluten sensitivity Coeliac disease - blood (Total IgA, IgA tTG,EMA)/biopsy and HLA DQ typing all positive Biopsy remains gold standard Potential Coeliac - HLA DQ typing positive, raised intraepithelial lymphocytes maybe positive antibodies, family history too NCGS - negative of the above, innate immune response causing/occurring? My view - NCGS vs IBS tricky.... If history of allergies is patient or family ?More like NCGS due to immune mechanisms (Marianas Williams did a gastro webinar 2014/2015 and mentioned this = logical to me) My further reading -HLA DQ alpha & beta-1 (90-95% cases) and HLA DQ-8 haplotype are 3 genes that are +ve for coeliac disease to occur. HLA = human leukocyte antigen is a 'gene complex' of the chromosome. Many different alleles, the 3 above are coeliac related. -Positive blood tests include the antibody anti-tTG (tissue Transglutaminase) and EMA (endomysial antibodies) and total IgA.... Some people have IgA deficiency - wouldn't show +ve blood test! Hence biopsy gold standard! - T-cell mediated gluten sensitive enteropathy A.K.A coeliac disease! Changing practice -be considerate of gluten sensitive patients and PMHx/FHx to consider diverting between CD, NCGS, Potential CD, IBS - be more aware with lexis regarding coeliac disease and more comfortable analysing patient information/test results

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Quite liking the new eatwell guide... Hydration message Calorie guide Food label education Only leaving oils and spreads in the purple section Think they've done well!

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Head and neck patient case study - peg feed, constipation and planning

SITUATION - H&N patient on bolus feed of compact style ons, should have 7 a day, managing 2/day and retching. Having 1 sloppy meal. Finished RTx, but will now get worse for 2-3 weeks. Bank holiday weekend upcoming too, wife and patient very distressed. H&N dietitian away, not my usual area so not experienced. TASK - Maintain weight, reduce symptoms if possible. ACTION - Pump feed, emergency equipment and training request. RESULT - Specialist nurse said no, convinced patient to say no. Learning points.... Missed that they were constipated and therefore could not take much orally or through PEG. Should have spoken with CNS about situation, she'd have pointed it out All of that would have saved me time and had a better outcome for patient sooner Next time.... BOWELS!! CNS!

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Highlights Those on ONS lost make weight - but was this the reason they were put on ONS? Aim over 30kcals/kg/day