Wednesday, January 30, 2013

Traditional Fairy Tales, Healthy Nutrition and Just Great Food

"Read for Health" is a University of Maryland Food Supplement Nutrition Education (FSNE) curriculum that combines reading in elementary schools with activities including food prep.  Children ages 5 through 12 participate in ChildFirst sponsored after-school activities at Baltimore's BayBrook Middle School.

In one book -- Berry Tales -- Goldilocks ate Pappa Bear's cold oatmeal, ate Mamma Bear's (browned) bananas and drank Baby Bear's warm milk -- all of which had been left sitting on the table for 3-4 hours.  As expected Goldilocks got food borne illness (food poisoning).  With a little twist to the story -- the 3 bears took care of Goldilokcs until she got well.  For the children this story represents one more way to reinforce the need for proper food safety including hand washing, and proper food storage.  As much as the children enjoy the books -- their favorite part is the "cooking" portion of the class.

This week we made cold whole wheat pasta salad with raw vegetables and low fat salad dressing.  As the food items for our cold pasta salad were introduced -- one child said -- "Ugh mushrooms - they are nasty" - but still agreed to help cut up the carrots and mushrooms (the hardest ones to cut with our plastic knives). 

Younger children cut up peppers (yellow, red and green), squash (yellow and green), and picked the cherry tomatoes.

We then mixed all of this into our cold whole wheat pasta.  Amazing the child who said "ugh" to the mushrooms -- ate two servings of the pasta salad he helped to make and then wanted to take some home to show his family.  Finally during the class we reviewed how the Baltimore Ravens (soon to be Superbowl Champions) had changed their diet starting with 2012 practice; they replaced white bread, white rice and white pasta with whole wheat and reduced fat versions and picked healthier food options.  Read this article for more information.  So like the Baltimore Ravens -- we want to eat healthier to be more successful in our activities.

Posted on behalf of Phyllis McShane

Monday, January 28, 2013

Gearing Up for Clinical

Dear Future Intern Class,

Now that I have finished food service, information technology, and am wrapping up community, it’s almost time for the “nerve-wrecking” and “intimidating” clinical rotation.  Honestly, I thought I would be more anxious, but I’m actually excited to finally gain experience and work directly with patients.  

Currently more than half of the Maryland interns have experienced life as a hospital dietitian.  Therefore as my clinical date approaches I have been constantly asking them how to prepare for my last big rotation.  For future interns, I have compiled a list of helpful ways to prepare your clinical rotation. 

          - Review all major disease states, conditions, and common medications

-             - Carry a clip-board to hold your notes and cheat-sheets 

-             -  Go through each body system, (reviewing function and importance

-             -   Familiarize yourself with common lab tests and what is being measured 

-             - Take a minute and BREATH

Harbor Hospital
Obviously you can only be so prepared and will learn a lot on the job, but thanks to my fellow interns I am no longer scared for my first day of clinical.  If anything, I am looking forward to becoming more confident in myself as a dietetic professional and perhaps even gaining a little clinical judgment.  My first day at Harbor Hospital in Baltimore is February 26th and it can not come any faster.  


Thursday, January 24, 2013

World of Inpatient Pediatrics

          Two weeks ago the University of Maryland dietetic interns had an opportunity to attend a joint class day hosted by Children’s National Medical Center. The class day consists of a series of lectures covering topics on providing medical nutrition therapy for the pediatric population. The lectures included information on: Infant Formula, Enteral Nutrition, Parental Nutrition, Inflammatory Bowel Disease, Short Bowel Syndrome, Neonatal Nutrition, Oncology, Cystic Fibrosis, Allergies, Metabolics and Genetics.  It was a lot of new information that I have never learned about during my undergrad. After completing my two clinical rotations, my partner and I were the first set of interns to start our rotation at the Children’s National Medical Center this year. We each chose two different areas that we would like to focus on and I chose Gastroenterology and Cardiology.
One thing that I learned this past week in my GI rotation was that providing medical nutrition therapy for the pediatric population is completely different from the older population.
Here are some issues to consider when working with the pediatric population:
  • Is the patient able to provide a complete diet history? Are there parents present at the time of the interview?
  • What special psychosocial considerations need to be considered when dealing  with an adolescent population.
  • Are the parents mixing formulas correctly or following the recipe provided?
  • What issues need to  be considered when discharging a child on a new tube feeding or TPN?
  • Who is the caregiver and is that person aware of any special diet instructions?
  • Does the patient’s medical diagnosis increase calorie or protein needs?
  • Do you have the skills to complete growth charts to track the growth of infants, children and adolescents.

It was a great experience being able to work with the GI team and learn how to provide medical nutrition therapy for a pediatric population. I am definitely looking forward to my next peds rotation in cardiology!

Monday, January 21, 2013

Cooking for a Crowd

by: Melissa Grindle

This past Friday was our internship Theme Meal at Riderwood Village.  We spend 6 weeks at this location learning about food service and developing our kitchen skills.

It takes roughly four weeks to completely plan, market, price, and develop the menu for the theme meal.  We are told to plan for 100 - 120 residents to attend the meal, and with that forecast we can begin to prepare.  But, first you must pick a theme!  Wendy and I decided on Caribbean Cruise theme meal to warm us up in the middle of winter.  We featured foods such as Rum Cake, Coconut Chickpea Curry, Red Beans and Rice, and Chili Lime Grilled Steak.

The Pre-Sale Tickets

While both of us would claim to have decent kitchen skills, translating those skills to a commercial kitchen is completely different.  Spices do not just multiply and baking becomes more complicated in large quantities.  Keeping this in mind, we more than welcomed the help from the chef and kitchen manager of the Windsor Dining Room.

Selling pre-sale tickets for our meal

The Tuesday before the meal (the meal being Friday afternoon) is when all the prep starts!  The creation of our production schedule was probably the most helpful portion of our prep.  We knew each day the tasks ahead and approximately how long it would take us to complete.  Chopping, grilling, and baking took place for at least 8 hours each day.  Not only did we have kitchen work, but we also decorated the dining room to feel like to dining room on a cruise ship.

Our favorite decoration - Inflatable Palm Trees!

So how did it all turn out?  Well according to the residents, we believe it was a huge success!  Of course day  of chaos occurred, but when you have 14 things to do at one time, when wouldn't that happen?  With a great crew, internship partner, and support system, our theme meal was an event never to forget!

Wendy and I with our Kitchen Manager - Jason

What I'll take away from this rotation is how much goes into just one meal.  We fed just a quarter of the people the kitchen feeds daily, yet the preparation that goes into just that was outstanding.  I will forever have a respect for the daily endeavors of the kitchen staff as a future dietitian.

Thursday, January 17, 2013

UMD Interns Host a Class Day: Nutrition, Communication, and Information Management

It’s January and for many seniors majoring in dietetics it’s a very scary time. In a couple months the competitive match for a dietetic internship will take place. It is hard to believe it has almost been a year since the 2012-2013-intern class was sending in our applications to the University of Maryland Dietetic Internship.

This past Monday, the University of Maryland hosted a joint class day at the Natural Agricultural Library for all the dietetic internships in the area, sharing a taste of our technology emphasis with our nutrition community.

A few of the cutting edge presentations at the class day included: Communication in the Digital Age; Telehealth and Weight Management in the 21st Century; Text4Baby; Text2BHealthy; Self Promotion and Marketing: using blogs and social media to find career opportunities; and Nutrition Education: Adult Learning and Behavior Change.

The class day had me engaged and on the edge of my seat all day!

Some of the key technology messages covered included:

  • ·      The evolution of technology provides new opportunities for the way society functions and we all have a responsibility to help foster understanding and growth within those opportunities so as a society  we can prosper without leaving some behind
  • ·      Social Media Changes the way problems are solved and opens up an opportunity for more people to have a voice and get involved
  • ·      As technology grows so do chances for dietitians and other health care professionals to reach more people in more places to provide them with individualized health care.
  • ·      Taking advantage of technology tools can provide new cost effective platforms to spread nutrition information

Overall, the day consisted of presentations, networking, great food, and even a QR code scavenger hunt! There is a lot to look forward for the next class of University of Maryland Dietetic Interns so hold on during this tough application process! 

Thursday, January 10, 2013

Does the “Perfect” Dietary Guidance for Clients Exist?

By Nikki Bolduc

On Tuesday, Maria and I had the opportunity to attend a conference put on by a coordinated dietetics program.  Lecturers focused on public health and included individuals from the government as well as from corporations that represented large companies in the food industry.  Topics included new FDA regulations on menu labeling, FDA’s plans to revise the Nutrition Facts panel, preventative initiatives put forth by the CDC, and much more. 

A comment from one of the attendees toward the end of the lecture struck a chord with me – the question highlighted a discussion involving the Grocery Manufacturers Association and whether their loyalties lay with industry or the consumer when it comes to nutrition guidance. 

What exactly is the “perfect” nutrition-related advice we can give our clients?

I pondered the discussion well into the evening.  Although it seems such a simple concept for a room of dietitians-to-be (i.e. fruits, vegetables, whole grains, lean protein, etc.), it is truly complex.  The first question to ask yourself is: who is your client?  Are they single, married, have kids?  Who makes meals at home?  Do they have any religious restrictions?  Do they have a food allergy, intolerance or sensitivity?  Do they deal with chronic disease?  What is their family history?  Where do they work or can they work?  What can they afford?

Sometimes it seems that we are trying to find the one solution to our nation’s many problems, such as obesity and chronic disease.  However, the answer lies in the fact that our profession is client-specific.  There are many factors to consider when you develop recommendations for a client. 

Our profession forces us to think outside-the-box.  No two nutrition recommendations will be the same.  Some people may see that as a limitation, but I see it as a fantastic challenge.

Monday, January 7, 2013

Diet Advice Isn't Always What You Think It Will Be

           Today we had a joint class day that included interns from Howard University and NIH.  The Children’s National Medical Center was our host and we heard a diverse set of lectures including:: Infant Formula and Enteral Nutrition, Critical Care and Parenteral Nutrition, Introduction to GI: IBD, Celiac, and Allergies, Cystic Fibrosis, Neonatal Nutrition, Oncology and Bone Marrow Transplants, and Metabolics and Genetics.  That’s a lot of information!  This was to prepare us for our two week rotation at Children’s.  We each get to work in two departments, so by having this class day, we were exposed to the work done in seven of them.  
            One lecture that I found especially interesting was given by Allison Becker MS, RD, CDE on cystic fibrosis.   She began by explaining what the disease is, a layer of thick, sticky, mucus that builds up in the lungs and other parts of the body.  Because of this, patients are prone to lung infects and constantly struggle when breathing.  This leads to a very specific diet plan: eat as many calories as you can and choose foods high in fat and salt.  Sounds pretty counter-intuitive, doesn’t it?
            Cystic Fibrosis increases a patients energy expenditure, requiring them to consume sometimes more than double the calories of a healthy individual.  In order to do this, fat is a huge ally.  It has 9 calories per gram compared to 4 calories per gram from both carbohydrate and protein.  By adding fat to meals and snacks, you get more bang for your nutrition buck.  In order to get enough calories, some of Allison’s recommendations included adding: 

  • Cheese on sandwiches, salads, veggies, and meat
  • Heavy cream in milk, mashed potatoes, gravy, and milkshakes
  • Butter or margarine to all foods
  • Bacon or sausage to breakfast

 These are all simple ways to add more calories into a diet.  Another recommendation is to consume high levels of salt.  Part of the condition involves sweating, resulting in sodium losses.  Children and adults can choose high salt foods, but for infants, 1/8 - 1/4  tsp (1-2 small packets from a fast food restaurant) should be added to breast milk, formula, or baby food.   

            Patients with cystic fibrosis currently have an average life expectancy of 37, up from 25 in 1985.  Even with this dramatic increase in life expectancy, chronic heart disease does not appear in these people, despite the increased fat and sodium intake.  Considering that the message to reduce these nutrients is predominant in our society, it can be hard to accept this.  This case does demonstrate the difference between the needs of a healthy person and the needs of someone with a condition like cystic fibrosis.  It was great to hear about this and understand just how varied the advice in this field can be, and still be appropriate.

Thursday, January 3, 2013

Enhancing and Promoting

Four weeks ago, I began my second information technology rotation at the Food and Nutrition Information Center (FNIC) of the USDA. While at FNIC, I worked with, one of FNIC’s special project areas. serves as a portal for consumers to find a host of government resources on nutrition, healthy eating, physical activity, and food safety. This site has over 1,000 links spanning across the federal government!

My main focus at FNIC has been to promote two videos and enhance their supporting pages. The first video, Kids Rock Nutrition in the Kitchen, shows kids cooking healthy and creative meals. The second video, Farmers Markets: Fresh, Nutritious, Local, features a registered dietitian promoting the benefits of shopping at a farmers market.

Enhancing the web pages was much easier than initially anticipated. I organized the site and added different titles, new links, bright photos, and colorful promo boxes. I made these changes by using a content management system, Drupal. I caught on quickly and really had fun with it! Below are screen shots of my improvement to the Kids in the Kitchen web page. PicII

In order to promote the new videos and resources, I developed a spreadsheet with a list of potential contacts. This list included government, educational, and professional websites, local health educators, WIC state agencies, universities, listservs, and more. By using Google Analytics, I have gained valuable information about pageviews and site visitors.

As I finish my final week at FNIC, I will be analyzing my efforts in enhancing and promoting these videos and will hopefully see increased webpage engagement. I have thoroughly enjoyed my time at FNIC and have developed so many new skills working with Drupal, Google Analytics, and an incredible team of registered dietitians.