Thesis Defense: Passed!

Today, I gave my hour-long thesis defense presentation to my committee and additional faculty and students and thankfully… I passed!  Now, all that stands between me and graduation are a few exams in genetics and finalizing my thesis document!

Here was the final presentation that summarizes my research!

WVU Davis College 18th Annual Research Day!

Today was WVU Davis College of Agriculture, Natural Resources and Design Annual Graduate Research Day.  At this event my abstract was accepted and I presented a poster presentation of my research. Tomorrow is my final defense presentation where I will share and defend my results to the public as well as my committee members!

 

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is the most common reproductive endocrine disorder in females. Genetic and lifestyle factors influence the etiology and insulin resistance plays a key role in the pathogenesis of PCOS.

Objective: To investigate the current trends and future implications of multidisciplinary PCOS clinics while emphasizing the role and challenges for dietitians.

Design: The study design was a two-phase formative investigation of PCOS focused practitioners through an anonymous, internet-based survey (Qualtrics, Provo, UT) followed by focus groups done via teleconference. Focus group data was analyzed using Braun and Clark’s method of thematic analysis.

Participants: Survey respondents included 261 health care providers, 59% physicians, 20% dietitians, from around the world (64% from the United States); the majority (59%) represented multidisciplinary facilities. Focus group participants included four dietitians, three physicians, a health psychologist and a licensed nutritionist that had 7-25 years of experience treating PCOS.

Results: From the survey, the barriers for future multidisciplinary clinics included: money/resources, insurance reimbursement, and difference of opinions; the potential advantages included: more comprehensive and integrated care, greater convenience/efficiency, better long-term outcomes, and increased access to disciplines. Dietitians were involved in 71% of the clinics represented in the survey and 89% of respondents stated that dietitians need to be ‘involved’ or ‘highly involved’ in PCOS treatment. Focus group participants stated the greatest challenges for dietitians include insurance, lack of PCOS knowledge, and lack of physician referrals. Overall, nutritional interventions are not very accessible for the majority of PCOS patients.

Conclusions and Implications: PCOS is a complex condition that requires the expertise of multiple provider types to treat the syndrome in its entirety. Most providers agreed that multidisciplinary clinics would ultimately lead to a better prognosis for PCOS patients. A greater emphasis needs to be placed on educating the medical community, including dietitians and physicians, on the importance of specialized nutrition counseling and lobbying for insurance reimbursement. Having access to dietitians educated on PCOS is likely the best way to ensure that PCOS patients have access to lifestyle interventions, which is considered to be the first-line treatment for PCOS.

 

Here is a copy of the poster I presented!

Davis College_Wendy Thompson PCOS

Click here to download PDF version!

Dietetic Internship: Complete!

As of today I am officially done with my 1,200+ hours of dietetic internship rotations!  Once I finish up my coursework, present and defend my thesis I will be finished with my Masters of Science in Human Nutrition and be eligible to take the RD exam to become a registered dietitian!

At the end of May I will be beginning my next journey of beginning PA school at the University of Colorado at Denver to ultimately become a Physician Assistant!

 

excitement

WIC Internship Rotation

These past two weeks I spent the majority of my time in the Monongalia and Marion County WIC offices.  With this rotation I was able to learn all about what WIC has to offer!  WIC represents the Women, Infants and Children Program, which is a federally funded nutrition education and supplemental food program.  This is an excellent opportunity for families that qualify to receive nutrition education, breastfeeding support/education, and assistance with food and other resources.  They are even working with the WIC-ICE program to offer free immunizations for children 0-5 years old!

http://www.monchd.org/wic-enhanced-health-nutrition-services.html

While at WIC I realized that the number of women choosing to feed their baby using formula outnumbered the number of women breastfeeding tremendously! Out of curiosity I ended up looking up the breastfeeding rates for the states of West Virginia and Colorado as well as the national rates.

Data from CDC’s Breastfeeding Report Card, 2013

Breastfeeding Rates

View entire report here!

Source: http://www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf

Curious to know which state had the highest and lowest rates of exclusive breastfeeding at 3 and 6 months? I was!  I found that the highest rate of exclusively breastfeeding at 3 months came from Idaho with 60.3% and the lowest came from Mississippi with only 17%.  When looking at the those exclusively breastfeeding at 6 months, the highest came from California with 27.4% and the lowest was Tennessee with only 4.1%.  As you can see there are very large discrepancies when comparing each state!

Why is it important to breastfeed vs. formula feedings?

Here are a few of the many wonderful benefits:

  • Reduce the risk of diseases in the infant such as:
    • Necrotizing enterocolitis
    • Lower respiratory infections
    • Asthma
    • Obesity
    • Type 2 Diabetes
    • SIDS
  • Protects the baby from illnesses so they get sick less often
  • Provides benefits to the mother and helps the body return back to ‘normal’ by:
    • Burning extra calories to promoting weight loss
    • Causing the uterus to contract to prevent bleeding
  • It is safe! No need to worry about:
    • Mixing the formula
    • Safety of the water
    • Selecting the right formula
    • Formula safety recalls
  • The cost savings!

One interesting thing I learned at WIC was the cost of formula! Did you know that the average cost of formula for the first year was $1,500 dollars just for basic formula!  This number would sky rocket if an infant required a special formula (very common since formula is harder to digest than breast milk)!  This number also does not include the cost of bottle and supplies!

So, why do so many women chose not to breast feed when it is the best nutrition and supplies of a wealth of benefits for the baby and the mother that will last a lifetime – and not to mention the cost savings?

Breastfeeding
Source: http://www.womenshealth.gov/breastfeeding/why-breastfeeding-is-important/index.html

Van Liere Research Day

This Friday, February 28th I will be presenting my research at the poster exhibit for the 2014 Annual E.J. Van Liere and Health Science Center Research Day.

I have attached my poster as a PDF below!

Click Here to Download PDF

References:

  1. Okoroh EM, Hooper WC, Atrash HK, Yusuf HR, Boulet SL. Prevalence of polycystic ovary syndrome among the privately insured, United States, 2003-2008. Obstet Gynecol. 2012;207(4):299.e1-299.e7. doi: 10.1016/j.ajog.2012.07.023.
  2. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544-551. doi: 10.1093/humrep/dep399.
  3. Teede HJ, Misso ML, Deeks AA, et al. Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline. Med J Aust. 2011;195(6):S65-112.
  4. Geier LM, Bekx MT, Connor EL. Factors contributing to initial weight loss among adolescents with polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2012. doi: 10.1016/j.jpag.2012.06.008; 10.1016/j.jpag.2012.06.008.
  5. Lamb J, Closshey W, Huddleston H, Davis G, Zane L, Cedars M. A multidisciplinary polycystic ovarian syndrome (PCOS) clinic: A new model for care and research. Fertil Steril. 2007;88:S186-S186.
  6. Humphreys L, Costarelli V. Implementation of dietary and general lifestyle advice among women with polycystic ovarian syndrome. The journal of the Royal Society for the Promotion of Health JID – 101499616. 2008.
  7. Jeanes YM, Barr SF, Smith K FAU – Hart,,K.H., Hart KH. Dietary management of women with polycystic ovary syndrome in the United Kingdom: The role of dietitians. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association JID – 8904840. 2009(1365-277).

Nutrition Case Study Presentation

It is crazy to think that my rotation is already wrapping up!  I have learned so much information and practical information that will help me to succeed as a dietitian and a health professional.  As a final evaluation of my performance as a dietetic intern I was responsible for identifying a patient to follow for a case study.  After conducting multiple nutrition assessments on my patient for the past few weeks I complied the information I learned into a presentation that I presented to all of the registered dietitians – about 10 of them.

<div style=”margin-bottom:5px”> <strong> <a href=”https://www.slideshare.net/wmthompson/nutrition-case-study&#8221; title=”Nutrition case study” target=”_blank”>Nutrition case study</a> </strong> from <strong><a href=”http://www.slideshare.net/wmthompson&#8221; target=”_blank”>Wendy Thompson</a></strong> </div>

Nutrition Topic of the Week: Parenteral Nutrition

What is Parenteral Nutrition (or TPN)?

As you all know – everyone needs food/nourishment to live!  So… what happens when a person is unable to eat normally or tolerate a tube feeding or cannot get enough intake? That is were parenteral nutrition comes in.  Parenteral nutrition refers to feeding through the vein, or intravenous nutrition.  This is very different from enteral nutrition because it does not enter the digestion pathway.  Parenteral nutrition (PN) bypasses the normal digestion process (ingested food is broken down in the stomach and the intestines, absorbed in the bowel, and carried by the blood throughout the body).  PN in inserted directly into the blood stream via an IV catheter to the vein bypassing the digestive tract.  This is a sterile formula that is mixed in the pharmacy that contains water, amino acids, glucose, *lipids, vitamins and minerals and requires very close monitoring.  Note: it is very common for their to be a lipid (fat) shortage (or a different drug shortage) so at many facilities lipids are only give lipids on Monday, Wednesday, and Friday and in limited quantities.  Since parenteral nutrition may be someone’s only source of intake it is important that all essential nutrients are provided if PN will be used for a long duration. In addition to macronutrients, PN may also include electrolytes (sodium, potassium, chloride, phosphate, calcium, and magnesium) and trace elements (since, copper, manganese, and chromium).  There is currently a shortage on trace elements so they are typically not included unless the patients has been on PN for over 30 days.

Who May Need Parenteral Nutrition?

People of all ages may receive parenteral nutrition and the time may be relatively short or for as long as needed.  Patients may require PN for conditions or diseases that impair food intake, nutrition digestion or absorption. Common examples include: short bowel syndrome, GI fistulas, bowel obstruction, critically ill patients, severe acute pancreatitis, ulcerative colitis, or severe Crohn’s Disease.

How is Parenteral Nutrition Supplied?

An IV catheter (needle) is placed a large vein in either the arm, chest or neck. Common names for these catheters include: PICC, triple lumen, double lumen, single lumen catheter, and ports.  Parenteral nutrition can be supplied continuously over 24 hours or cyclically down to about 12 hours a day.  An infusion pump will control the rate at which the solution is supplied.  Total parenteral nutrition (TPN) will need to be administered through a central access vein such as the chest or the neck and can be supplied in higher concentration to meet the needs of a patient who is relying solely on TPN for nutrition.  Peripheral parenteral nutrition (PPN) is administered in lower concentrations and can be given through a peripheral vein such as through the arm and is mostly used for patients who are also consuming food through another source.  TPN lines will go through a major vein and end at the superior vena cava.

What are the Potential Complications of Parenteral Nutrition?

  • Infection – can be a common complication because of the chronic IV access point. If the infection is severe enough septic shock and death could ultimately occur.
  • Blood Clots – if a blood clot forms in the IV lines but breaks off and enters the lung then death can result from a pulmonary embolism. Patients on long term tube feeds typically receive a Heparin flush periodically to dissolve clots.
  • Liver Damage and Liver Failure – may appear as jaundice
  • Cholecystitis – inflammation of the gallbladder
  • Osteoporosis – bone disease
  • Refeeding Syndrome – characterized by hypokalemia, hypophosphatemia and hypomagnesemia (or low serum potassium, phosphate, and magnesium levels)
  • Hyperglycemia – high glucose levels, can be controlled with insulin

How is Parenteral Nutrition Monitored?

Depending on the facility, TPN will usually be monitored by a nutrition support care team that may include a physician, dietitian, pharmacist, and nursing staff. It is crucial to the patient’s safety that labs be monitored frequently in addition to monitoring weight status. The following labs should be closely monitored so that the order can change as needed:

  • CBC – Complete Blood Count
  • Electrolytes (Sodium, Potassium, Calcium, Phosphorus, Magnesium, Chloride, Bicarbonate)
  • BUN – Blood Urea Nitrogen
  • Glucose Levels
  • Albumin/Pre-Albumin
  • Triglycerides

 

TPN Formula - No Lipids

TPN Formula – No Lipids

TPN Formula with Lipids

TPN Formula with Lipids

PN Routes

PN Routes

References:

http://www.nutritioncare.org/wcontent.aspx?id=270

http://transplants.ucla.edu/body.cfm?id=70

http://www.merckmanuals.com/professional/nutritional_disorders/nutritional_support/total_parenteral_nutrition_tpn.html