RDN thinking - Registered Dietitian Updated: 2023
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RDN Registered Dietitian
The Registered Dietitian (RDN) certification is a professional credential for individuals who have completed the necessary education and training in the field of nutrition and dietetics. The certification is administered by the Commission on Dietetic Registration (CDR) and is recognized in the medical and healthcare industry. This description provides an overview of the RDN certification.
The RDN certification requires completion of specific education and training requirements in the field of nutrition and dietetics. The course outline may include the following topics:
1. Nutrition Sciences:
- Biochemistry and metabolism
- Nutrient composition and analysis
- Macronutrients and micronutrients
- Food science and technology
2. Medical Nutrition Therapy:
- Clinical assessment and diagnosis
- Nutrition intervention and monitoring
- Disease-specific nutrition management
- Nutritional support and therapy
3. Foodservice Management:
- Menu planning and development
- Food production and service
- Food safety and sanitation
- Quality assurance and control
4. Community and Public Health Nutrition:
- Health promotion and education
- Public health programs and policies
- Community nutrition assessment
- Nutrition counseling and behavior change
5. Research and Evidence-Based Practice:
- Research methodology and design
- Data analysis and interpretation
- Evidence-based practice guidelines
- Research ethics and dissemination
The RDN certification test evaluates the candidate's knowledge and competence in the field of nutrition and dietetics. The test objectives may include:
1. Understanding of nutrition sciences and their application in health and disease.
2. Ability to assess nutritional needs and develop appropriate interventions.
3. Knowledge of medical nutrition therapy for various diseases and conditions.
4. Competence in foodservice management principles and practices.
5. Understanding of community and public health nutrition concepts and strategies.
6. Familiarity with research methodologies and evidence-based practice in nutrition.
The test syllabus for the RDN certification may cover the following topics:
1. Nutrition Sciences and Biochemistry
2. Medical Nutrition Therapy and Clinical Assessment
3. Foodservice Management and Menu Planning
4. Community and Public Health Nutrition
5. Research Methods and Evidence-Based Practice
Medical Registered thinking
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What are some advantages of using carbohydrate counting instead of food
exchanges when following a diabetic diet plan?
A. Carbohydrate counting permits greater flexibility in food choices.
B. Individuals who count carbohydrates can save up all of their allotted
carbohydrate for one meal.
C. There are more free food choices when counting carbohydrates.
D. Carbohydrate counting emphasizes high fiber foods.
An advantage of using carbohydrate counting instead of food exchanges when
following a diabetic diet plan is that carbohydrate counting permits greater
flexibility in food choices. When using carbohydrate counting, 15 grams of
carbohydrate from bread, fruit, or milk all serve as one carbohydrate serving, in
contrast to the exchange system in which foods from different exchange groups
contain varying amounts of carbohydrate. Use of carbohydrate counting still
requires equal distribution of carbohydrate over meals and snacks, and attention
to the amounts of free foods consumed.
In ice cream, overrun:
A. Is a measure of the volume of air whipped into the mix
B. Is usually 70-80%
C. May be affected by the type of ingredients used
D. All of the above
Overrun in ice cream is the increase in volume caused by agitation. The industry
standard for overrun is 70-80%. Overrun may be affected by the type of
ingredients used (i.e., heavy vs. light cream).
Which of the following food additives is an emulsifier?
B. Sodium propionate
D. Butylated hydroxytoluene
Lecithin is an emulsifier used to prevent mixtures of fat from separating. Gelatin
is a protein used as a stabilizer, and sodium propionate and butylated
hydroxytoluene are preservatives used to prevent food spoilage.
Whipped egg white is an example of what type of dispersion:
A. Solid in a liquid
B. Gas in a solid
C. Gas in a liquid
D. Liquid in a liquid
Whipped egg white is an example of a gas in a liquid, resulting from air beaten
into the white.
The characteristic fishy odor of seafood that is not fresh is due to:
A. Urea nitrogen
B. Hydrolyzed peptides
D. Branched-chain amino acids
Answer: C -The characteristic fishy odor of seafood that is not fresh is due to
trimethylamine, an amino acid breakdown product. Urea nitrogen is a measure of
human renal status, hydrolyzed peptides are partially digested amino acids found
in the human gut, and branched-chain amino acids are amino acids with side
chains containing two or more carbon atoms.
A needs assessment to determine a client"s readiness to receive diet instruction
might include which of the following considerations?
A. Personal interest of the client
B. The client"s income and educational level
C. The RD"s teaching schedule
D. A & B
A needs assessment determining a client"s readiness for instruction should be
based on the client"s personal interest, income and educational background. The
schedule of the RD is irrelevant.
A cross-sectional study is used when a researcher wants to:
A. Compare frequencies of many different diseases in a community over a year
B. Collect information about one type of disease in a group of people over a
defined time period
C. Measure lab values of study subjects at specific intervals
D. Control for confounding factors
A cross-sectional study is used to collect information about one type of disease in
a group of people over a defined time period. Cross-sectional studies are not used
to compare multiple diseases. Confounding factors are exposures or variables that
may affect the outcome of a study, and which study investigators control for using
Proxemics refers to:
A. The ability to read small print
B. Formulas used to calculate electrolytes in enteral feedings
C. A management style used in major corporations
D. An individual"s position, orientation, and distance from other people in a room
Proxemics refers to the manner in which an individual positions himself in a
room, in relation to other people. Counselors can use the distance between people
to assess how comfortable individuals are in the classroom and other learning
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On average, around 4,500 drugs and medical devices are pulled from shelves across the United States each year.1 This alarming statistic underscores the importance of controlling and mitigating risk in healthcare-related products. latest updates to regulatory guidances and standards are encouraging life sciences companies to step up their risk management efforts by infusing risk-based thinking into their entire quality ecosystem. For example:
Healthcare providers need to have the necessary medical devices available to perform procedures. Unless a device is fully compliant with the regulations, it cannot be used where it is needed. With more robust global regulatory requirements being enforced, companies will need to revisit their core quality system processesâparticularly risk management.
Overall, employing risk-based thinking throughout the organization is important, but how do companies put risk policies and procedures into practice? Most often, risk management is viewed as a requirement to meet regulatory compliance. The guidances and standards leave the âhowâ up to the companies. Some of the most common methods for assessing risk includeÂ a risk matrix, a risk register, and a failure mode and effects analysis (FMEA). But what is really needed is a practicable and effective risk management system within the organization.
Risk management needs to be a continuous, iterative process. It involves employing a systematic, data-driven approach to monitoring trends and identifying and mitigating risks before they result in costly delays, rework, or product recalls. Individual events such as out of specifications (OOS) and other deviations are easy to silo and overlook as part of a larger risk. For instance, there could be a new risk that may have been missed or an unforeseen hazard that now needs to be monitored. That said, risk management is not a quality-only responsibilityâit needs to be integrated into all areas of the company.
Much of the impetus for making risk management an all-hands endeavor is attributed to advancing technology and more-sophisticated medical devices. Software-based medical devices are a prime example. More disparate entities (internal and external) are involved in the design and development of the components of these devices. All too often, defects or functionality discrepancies go undiscovered until later in the production process or postmarket. Risk management needs to start earlier and be performed in greater detail and at every stage of the productâs life cycle. Staff involved in product design, development, manufacturing, supply chain, etc. must participate in risk control and mitigation.
Setting up an effective risk management system involves effectively aligning people, processes, and technology. This all starts with building a risk management plan that includes clearly defined, documented policies, such as a policy for risk acceptability. Best practices include establishing organization-wide collaboration, clarifying priorities, and empowering people in all areas to make decisions, including stopping production if necessary. This way all employees understand the purpose of the procedures as well as the overall goals of the risk management system.
To successfully implement this type of all-inclusive system means all stakeholders need the ability to access and share data in real time in order to more effectively track and trend risk data. The need for this level of interaction, speed, and efficiency renders paper-based or spreadsheet data collection and analysis impracticable.
With platform-based technology, every business unit can have an appreciableÂ impact on the companyâs overall risk management efforts. Integrating business unit-specific systems across the organization dissolves siloes, harmonizes disparate operations, and fosters real-time, company-wide communication. This augments the companyâs capacity for gathering quality data and making more confident decisions based on predictive insights.
Using technology to proactively monitor and control risk reduces regulatory interaction, which makes sense on a compliance and business level. In return, the organization experiences shorter product development cycles and faster regulatory clearance, reducing the overall cost of compliance. Regulators have greater assurance of the companyâs ability to identify and mitigate risks and develop safe and effective products. Essentially, the organization's risk management system becomes a catalyst for business success.Â
In February 2022, Mario Andres Espinosa Hernandez was nearing graduation from the UAB Heersink School of Medicine and was looking forward to Match Day in March, when he would learn where he has matched into residency. However, there was one more challenge for him to overcomeâone that arrived unexpectedly and with higher stakes than any he had previously encountered.
It was an ordinary Tuesday when Espinosa Hernandez headed to the gym to work out. There, something happened that changed two lives in dramatic ways. âI was doing my workout, and out of the corner of my eye I saw my friend crouched over a girl who was lying on the floor, and he was motioning for me to come over,â Espinosa Hernandez says. âIt looked like she was having a seizure.â
Leaning into his medical school training, Espinosa Hernandez says he thought about the ABCs (airway, breathing, circulation), felt for a pulse (which he says was âvery threadyâ), and began performing the jaw thrust maneuver to open her airway. A nurse who also happened to be at the gym hurried over to help. A few minutes later, Espinosa Hernandez saw that the womanâs face, lips, and fingers were turning blue, and he checked her pulse again and found none. He asked the nurse to begin CPR and asked another person to get one of the gymâs automated external defibrillators (AEDs). When they removed the womanâs shirt to place the AED pads, he noticed a long scar running down her chest. âI saw that and thought, âOh no, this might be cardiac. It could be very serious.ââ Indeed, once applied the AED diagnosed that the young womanâs heart was in a fatal arrhythmia.
It was a moment that could have triggered what Espinosa Hernandez says medical students call âimposter syndromeââthe feeling that, regardless of all the training, youâre not truly prepared to handle a life-or-death situation. Instead, he says the opposite sensation kicked in. âI didnât have time to be scared or nervous. My brain was like, âYouâve done the simulations. Youâve had the training. You know what needs to be done, and she may die without it.ââ
Espinosa Hernandez says he shocked her three times with the AED before the emergency medical system (EMS) team arrived. EMS shocked her again, finally bringing the woman back to a regular heart rate before rushing her to the ambulance.
Only then did the enormity of what had just happened hit Espinosa Hernandez. âWhen I knew she was at least temporarily stabilized, all of the emotions flooded in,â he says. âI was shaking, and it seemed like the entire gym walked up to me, asking me questions and calling me a hero. It was insane.â
Knowing his quick reactions had helped save a young womanâs life would have boosted the confidence of any medical student, but it held particular significance for Espinosa Hernandez. Growing up, he helped care for his mother, who suffers from multiple sclerosis. The two watched a lot of medical shows together, and he says he was hooked. âMy mom would call me her little doctor,â Espinosa Hernandez, whose family is from Puerto Rico, says. âI knew medicine was what I needed to do. I wanted to help people.â
Not surprisingly, Espinosa Hernandezâs first call after helping save the young womanâs life was to his mother. âWe were both on the verge of tears, because sheâs my motivation for everything,â he says. âShe told me she always knew I had it in me and said she was really proud of me. It made me feel, âI need to do this.ââ He says he felt in those moments like he genuinely belongs in medicine.
That hasnât always been the case. Espinosa Hernandez admits he occasionally struggled with doubt and insecurity while in medical school. âI sometimes had feelings of, âIâm different than a lot of the other medical students, Iâm from Puerto Rico, I come from a low-income household.â I thought maybe I didnât really belong,â he says. âBut I will always love UAB, because UAB was the medical school that gave me a chance. And then this happened, and it definitely gave me a boost of confidence.â
For several weeks, Espinosa Hernandez did not know the fate of the woman he had helped keep alive, until one day a staff member at the gym told him that her father was trying to track him down. âI called him, and it was very emotional,â he says. âHe filled me in on a lot of details. She has a congenital heart disease called Tetralogy of Fallot, and she had had open-heart surgery when she was 15 or 16 months old. She was actually scheduled to have another heart procedure done before the incident at the gym happened.â
Espinosa Hernandez learned that the woman spent several days in the ICU before being transferred to the hospital where her heart surgeon practices. Her father told him she had had the scheduled heart procedure and was home recovering well.
Today, Espinosa Hernandez has started residency training at the University of Florida in Gainesville. His specialty is an appropriate one: emergency medicine. âMaybe this is cheesy, but when I was a kid taking care of my mom, I really wanted to be a hero. One of the reasons I wanted to go into emergency medicine is I wanted to know what to do in case of an emergency, and this scenario has showed me that I achieved my dream.âÂ â Rosalind Fournier
The intent to keep oneâs New Year resolution only lasts two to four months before goal-setters supply up or forget about it, according to Forbes Health survey findings. Just under one in 10 (8%) say their resolutions have lasted a month, 21.9% report two months, 22.2% report three months and 13.1% say their resolutions have lasted four months in the past.
âWe often fail in achieving and keeping New Yearâs resolutions because they focus on a specific outcome (e.g., a precise body weight),â says Dr. Romanoff. When individuals focus on a particular outcome, it can be challenging to persevere in your efforts if results are not immediately apparent, she explains. âGoals take time, and many folks become discouraged and eventually relent before attaining the goal.â
Experts agree that setting resolutions that align with oneâs personal values (instead of a specific outcome) can serve as a great source of motivation. Additionally, setting short-term goals to stay motivated along the way toward bigger-picture resolutions can be helpful. To help individuals stick to their goals, our experts offer the following advice.
Link Your Goals to Your Values
âValues are never actually achieved, rather they operate as a compass, constantly informing and guiding our behaviors,â says Dr. Romanoff. Instead of focusing on a specific number on the scale, she suggests using your specific motivation to lose weightâwhether it be improved health or self-esteemâas a value to incentivize your goal. This can help ground your resolutions in purpose and contextualize them in a meaningful way, Dr. Romanoff says.
Create Short-Term and Long-Term Goals
One of the biggest factors that lead people to abandon their resolutions is setting goals that are unrealistic, according to Dr. Romanoff. âDivide your goals between those that can be accomplished either in the long or short term,â she suggests, adding that, âcreating an action plan that links the long-term goal with the near-term achievable and realistic goals will ensure success.â
Jeff Temple, Ph.D., professor, psychologist and associate dean of research at UTHealthâs School of Behavioral Health Sciences and Forbes Health Advisory Board member suggests setting goals that are specific and measurable. âYouâre more likely to succeed if your goal is: âI want to lose one pound per month for six monthsâ as opposed to: âI want to lose weight,ââ he says. It may also be helpful to enlist an encouraging, non-critical friend to keep you accountable, he says.
Dr. Ho recommends starting with small changes to help build confidence. âThings that you can shift in your habits a little at a time, beginning with something you can accomplish within a few minutes to 15 minutes a day,â she says. Some small changes Dr. Ho suggests are taking a walk around the block during your lunch break, tracking how much water you drink, doing a five to 10 minute yoga or stretch routine upon waking up and engaging in a hobby you enjoy for 10 to 15 minutes like knitting, playing music or drawing.
Make a Plan to Overcome Obstacles
Dr. Ho suggests assessing potential barriers and making a plan to navigate those barriers before they happen. âThis involves visualizing the barriers that might get in the way of your goals, and then making âif/thenâ plans for each barrier,â she says. For example, if youâre tempted to skip a morning workout, put on your running shoes and drive to the gym anyway, âbecause once you get to the gym, youâre much more likely to get out of the car and go in, at least for a few minutes,â notes Dr. Ho.
Be Flexibleâand Reward Yourself
Dr. Romanoff encourages individuals to have an easy grasp on their resolutions, and let go of any rigid thinking around them, as accommodating change and being adaptive can help resolutions stick.
Another key to sticking with your New Yearâs resolutions? Rewarding yourself for steps taken toward achieving your goals. âThis will shape and reinforce improvement and sustain motivation,â says Dr. Romanoff.
To do this, Dr. Romanoff recommends setting measurable benchmarks toward your goal. âFor example, if you walk 5,000 steps daily in the next month, buy yourself special headphones to use on your walks. If you exercise four days per week for the next three weeks, buy yourself a new workout set youâve been eyeing.â
Dr. Romanoff also suggests giving yourself a reward that extends beyond purchasing something, but rather focuses on how you spend your time or involves a valued activity. As a reward for making progress toward your resolution, Dr. Romanoff recommends giving yourself a spa night, eating your favorite dessert or giving yourself permission to have a lazy morning in bed.
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The Brazilian Unified Health System (SUS) was created in 1990 to implement the 1988 Brazilian Constitution health component, which established universal health access, including all aspects, as a fundamental right. 1 Although part of a unified system, health information systems (HIS) are historically part of specific verticalized control programs like malaria, tuberculosis, and hepatitis, which developed as independent initiatives in the past. Therefore, health information used to be fragmented into distinct databases. Reference Coelho Neto and Chioro2
An important landmark happened in 1975, when the Ministry of Health (MoH) promoted the first meeting on HISs to discuss the implementation of the main HIS. Reference Jorge, Laurenti and Gotlieb3
Thereafter, Brazilian HIS have substantially increased in quality, mainly in the last few years with the migration to web-based services enabling fast and secure data transfer from municipalities to the MoHâs servers and providing access to summary reports. These HIS allowed data collection in a patient-level granularity, allowing researchers, health professionals, and policymakers to conduct ecological and individual analyses. Reference Jorge, Laurenti and Gotlieb3
Among those HIS, we emphasize the Information System of Diseases Notification (SINAN), which stores data from all mandatory notification diseases, the Information System of Live Births (SINASC), responsible for collecting and storing data from all live births, and the Information System of Mortality (SIM), where death registers are collected and stored. Others HIS were developed for specific needs, such as SIVEP malaria (used to collect and store data of malaria infection in the Amazon region) and SIVEP gripe, used to collect and store data of severe acute respiratory syndrome in the whole country.
Despite the considerable advances in the last years, those HIS still need to overcome some critical issues, like the absence of a primary key to enable data from the same person to be linked quickly from the different databases. More essential, difficulties on broad Internet access poses an additional barrier to the timely availability of data so that epidemic detection can be performed in real time. Additionally, MoHâs open data policies are still unclear, sometimes only a byproduct of specific research projects. For instance, despite the efforts of the MoH to make COVID-19 data available during the pandemic, delays due to both the data entering and data availability are still observed. A chain of events in the notification process, which are also sources of delay, has posed an additional obstacle to monitor the pandemic in real time. Reference Bastos, Economou and Gomes4
Responses to epidemics require the ability to detect signs and symptoms quickly, even if the pathogen is unknown. The existing HIS are not thought to allow prompt epidemic detection because of their nature and limitations. Reference Bastos, Economou and Gomes4
In latest years, medical records are increasingly moving toward electronic platforms. These clinical registers are a rich source of patient information and epidemiological information, allowing for timely data, in-depth investigation of patient condition, follow-up, and sample availability for further analysis. Reference Ludwick and Doucette5
Here, we propose a complementary approach by using EMRs data collected from health units in real time to generate a user-friendly interface with visual analyses to enable insights from the local health surveillance system personnel. Details on the whole process can be viewed in FigureÂ 1.
A pilot project was proposed to be implemented in SĂŁo Caetano do Sul City (SCS), which is part of the metropolitan region of SĂŁo Paulo with an estimated population of 162,763 inhabitants, and the highest human development index (HDI) in Brazil (0,862). SCS has an integrated health system which includes information for all health facilities levels, from the basic health unit to hospitals. Also, the city presents a higher rate of chronic diseases and eventually outbreaks of infectious diseases. Reference Leal, Mendes-Correa and Buss6,Reference Luz, Santos and Sabino7
SCS has implemented EMR systems in the main hospitals and medium-level health units. Here, we used data from MV systems, medical records systems from Secretaria Municipal de SaĂșde de SĂŁo Caetano do Sul (SMS-SCS). MV is a broad-purpose third-party system developed to collect and manage hospital data. This system provides real-time data availability on medical charts, treatment, clinical management, and diagnostic results. Additionally, in April 2022, in the face of an urgent/emergency scenario related to the COVID-19 pandemic, the Corona SĂŁo Caetano Platform (CSCP) was implemented. The CSCP is an online platform for managing all activities and actions related to COVID-19, aiming promoting assistance to cases of COVID-19, combining remote care and home visits to collect samples for diagnosis, and integrating laboratory and clinical data related to the etiological diagnosis. The data on the suspected cases of COVID-19 are structured in an electronic database stored on servers with restricted and secure access. Reference Leal, Mendes-Correa and Buss6
As proof of concept, we chose âfeverâ as a sentinel event. Regular expression techniques were applied to allow the algorithm to recognize any word or expression that states febrile diseases. Other specific terms such as âmalaria,â âdengue,â âZika,â or any infectious disease were included in the dictionary and mapped to âfever.â Additionally, after âtokenizing,â we assessed the frequencies of most mentioned terms when fever was also mentioned in the patient complaint. The tokenization process consists of split words as distinct registers from a text field in a dataset. Additionally, stopwords as articles, prepositions, and verbs were excluded from the processed dataset. Reference Mullen, Benoit, Keyes, Selivanov and Arnold8,Reference Nandwani and Verma9
To reach real-time non-identified data from medical records, APIs were made available by the local team. Through these interfaces, we developed pipelines to collect, process, and provide visual analyses available in a dashboard. Both the processing and visual analyses were carried out by using R software (v. 4.2.1) and RStudio IDE (v. 2022.07.1). Additionally, the following libraries were used: flexdashboard, dplyr, lubridate, pyramid, ggplot2, bslib, stringr, wordcloud2, sf, tidytable, knitr, prophet, dygraphs, tidytext, and stringi. The scripts, as well as nonsensitive sample data, can be found at a Github project link: https://github.com/InstitutoTodosPelaSaude/SCS.
As a case description, here we present a dashboard and respective findings from SĂŁo Caetano do Sul, SĂŁo Paulo. 10
Data from a hospital and a medium complexity health unity from SCS were assessed. In 2022, from January to September, almost 120,000 medical appointments were performed in the two health facilities, with a daily average of almost 4,000. Out of the total registers, 11,400 had mention of âfeverâ in the patient complaint register. Most of the population were women with ages ranging from 20 to 49 years.
In the whole period, the most frequent terms mentioned when fever was also detected were pain in the throat, cough, headache, and coryza, with little variation within the last 6 months. The fever rates ranged from 1,050 to 1,025 per 1,000 inhabitants, and the highest were in FundaĂ§ĂŁo and Centro neighborhoods, in the northern region of the city (FigureÂ 2A). The fever rates, higher than the neighborhoodâs population, can be explained by both the quality of the SCS health system and the proximity to SĂŁo Paulo, the Capital.
FigureÂ 2B shows the time series of fever relating cases, which reveals a bimodal pattern, probably describing the Omicron BA.1 outbreak (weeks 1â6) and the Influenza A outbreak (weeks 20â30) through JanuaryâFebruary 2022. The main diagnostic hypotheses in the medical records of the first epidemiological weeks of 2022 pointed out the ICD J111 (Influenza â flu â with other respiratory manifestations, caused by unknown viruses), followed by B342 (infection by unspecified coronavirus). These findings raised flags to the overlapping outbreaks of both COVID-19 Omicron BA.1 subvariant and Influenza A virus, which were confirmed by our team by analyzing data from private laboratories and CSCP. Reference Leal, Mendes-Correa and Buss6,11
Several studies had been conducted on electronic health systems assessment. Most of them focus on the patient care by itself or propose new systems using different technologies or approaches, which implies additional costs or long learning curves to the public administration, as well as to the health workers. Here, we propose a new approach based on data from health systems, which despite not being designed for that purpose, aggregate a rich amount of data that can be used for decision-making on health surveillance.
The Brazilian MoH currently has to deal with more than 800 unconnected systems from the universal access health system, and most studies have been focusing on proposing new systems. Reference Coelho Neto and Chioro2 Besides being a tough challenge to gather these data, and generate useful information, data availability has to be timely to be able to produce actionable information.
The extensive data wrangling capacity needed to process those databases to be ready-to-use exhausted much of the time of the MoH team, further contributing to delays on data availability. This creates a culture of lack of validation of the information generated, posing additional difficulties on the much-needed evidence-based decision-making. In this regard, we strongly suggest the use of data already available through gathering and wrangling the data from the EMRs, from existing systems, without changing the processes or routines that have been functional.
Although not extensively validated, we were able to detect Omicron VOCs and Influ A outbreaks in SCS. The adoption of EMRs has been a trend in the health units due to the high Internet availability.
In the systematic review by Kruse et al., 2018, that wider adoption as well as the increasing interoperability of the electronic system have the potential to strengthen health surveillance and disease prevention. Reference Kruse, Stein, Thomas and Kaur12 Here we showed, by using available technology, that it is possible to point out local outbreaks before the official surveillance system.
However, it can be costly and time-consuming to process the amount of data generated by medical records, which were not projected for such epidemiological analysis. Thus, the minimum approach should be less time-consuming. Medical records encompasses a great variety of data on patient follow-up, including clinical and laboratorial reports that can be used in projects such as the one presented here. Also, despite the unstructured data nature, EMRs are less prone to delays than the traditional surveillance structured data. Structuring process introduces more steps on turning the data into information, with less structured data less steps are needed to process it, although giving nonspecific data, here fever relating cases.
The data gathered from medical reports can increase the quality of data, including anamnesis and accurate classification referring to ICD codes or even patientsâ complaints. Such an approach can add empowerment to local authorities with prompt information in the process of decision-making, which increases the velocity and accuracy to deal with outbreaks.
Most of the surveillance systems are filled by nonmedical professionals with little or even no expertise in clinical anamnesis. By using medical records, the accuracy of the suggested diagnostics tends to be better than those made by other nonmedical professionals.
Also, the data security of using medical records for epidemiological purposes needs to be considered. Beard et al., 2012, recalls the high demand for data and systems not prepared to meet data security basic requirements. Although progress has been made recently, it is still a main concern in the field when applying algorithms, pipelines of data wrangling and analysis, on data that has met anonymization principles before its usage. Reference Beard, Schein, Morra, Wilson and Keelan13
Therefore, preparedness can be built by teams and infrastructure that have the capacity to detect any anomaly referring to outbreaks caused by emerging and re-emerging pathogens. Making data fully available, only, will not be an end-most solution. However, the above strategy can work as an excellent sentinel surveillance system to detect early signs of new outbreaks.
Synergy between private sector health units and governments must be stimulated to the wide use and implementation of such systems of EMRs. Therefore, companies developing those systems could fill the gap of harmonizing and structuring databases for EMRs. To do so, the government should provide guidelines on those database structures. Timely information generated from EMRs will be a very important tool to the decision-making process as well as research in epidemiology. Quality and security on the data produced is of paramount importance to allow the use by health surveillance systems.
Back in the day, the office staff answering the phone was my means of protecting my time. They would take messages and deflect calls. Today, with the advent of portals, those protections have been lost, only to be replaced by the castle-guarding moat of email. I am not sure exactly how I feel about texting or email, although I must admit I am doing it more and more as a patient. But perhaps because I was âin the trade,â most of my digital communication has been relatively direct and free of charge. But charging for physician email response are becoming a thing.
The New York Times covered the problem earlier this year. Cleveland Clinic, along with the VA, among other health systems, is charging a âco-paymentâ for the service imposed on patients as we are all herded into patient portals for communication. Of course, there is a code for this digital service. CMS approved Medicare billing codes in 2019, and private insurers have followed suit to varying degrees.
There are some reasons why charging for those last-minute questions makes sense. First, in a world increasingly dominated by providers paid on the clock for their work (as relative value units), responding to email takes time. There is no doubt that email to physicians has dramatically increased during the pandemic, rising by 150% or more. Numbers are hard to come by, but physicians, on average, spend about an hour a day on their email, and at least a percentage of that is done outside the office â digital communications often blurs the work-life balance. Another study found that physicians spend a little over 2 minutes responding to an email question. One might note at this point that CMS requires a minimum of 5 minutes responding to initiate a bill for this digital service â but who is punching a time clock?
Responding to patientsâ questions, whether in person or virtually, is a form of medical consultation. At a minimum, the physician must be cognizant of the patientâs history, hopefully understanding their current health concerns and be able to access pertinent laboratory or imaging information in order to provide professional advice. Of course, when a physician gives advice, there attaches to use a legal phrase, liability. To adequately defend against such concerns, text messages must be added to the clinical record, an additional time cost.
Charging for email correspondence has resulted in a win-win for some bean counters. A study at UCSF before and after adopting a charge for email demonstrated that email messaging and back-and-forth texting decreased after fees were introduced, but virtual visits increased â those small email fees drove more patients into more remunerative e-visits. What is unclear is whether these charges, which reduce the demand for access, resulted in poorer care. One would hope that synchronous face-to-face communication, even over video, would be better than the asynchronous back-and-forth of texting. Looming large over that discussion are the disparities of care already baked into the system by those patients without the proper digital tools, insurance, or inadequate coverage for this form of care.
I freely admit I am no longer practicing, so my sense of how well the physician-patient relationship is maintained in these circumstances is unclear. To the extent that I prefer a face-to-face conversation over a telephone call, I am a curmudgeon. I use email extensively, but I am put off by texting. There is, of course, an entire generation raised on texting and email that may be far more comfortable, but I defer. On the other hand, as a physician, I have experienced the power of âlaying on of handsâ and soft conversation, so while I defer judging, I canât help but feel this digital back-and-forth will ultimately fail in the moments you need a physician the most.
A new study from The Ohio State University Wexner Medical Center and College of Medicine, University of Utah and University of Exeter (UK) substantiates previous groundbreaking research that rumination (overthinking) can be reduced through an intervention called rumination-focused cognitive behavioral therapy (RF-CBT). In addition, the use of functional MRI (fMRI) technology allowed researchers to observe correlated shifts in the brain connectivity associated with overthinking.
Study findings are published online in the journal Biological Psychiatry Global Open Science.
"We know adolescent development is pivotal. Their brains are maturing, and habits are forming. Interventions like RF-CBT can be game-changers, steering them towards a mentally healthy adulthood. We were particularly excited that the treatment seemed developmentally appropriate and was acceptable and accessible via telehealth during the early pandemic," said corresponding author Scott Langenecker, Ph.D., vice chair of research in the Department of Psychiatry and Behavioral Health at Ohio State, who started this project while at the University of Utah.
RF-CBT is a promising approach pioneered by Ed Watkins, Ph.D., professor of experimental and applied Clinical Psychology at the University of Exeter. It has been shown to be effective among adults with recurrent depression.
"We wanted to see if we could adapt it for a younger population to prevent the ongoing burden of depressive relapse," said Rachel Jacobs, Ph.D., adjunct assistant professor of psychiatry and behavioral sciences at Northwestern University who conducted the pilot study in 2016.
"As a clinician, I continued to observe that standard CBT tools such as cognitive restructuring didn't supply young people the tools to break out of the painful mental loops that contribute to experiencing depression again. If we could find a way to do that, maybe we could help young people stay well as they transition to adulthood, which has become even more important since we've observed the mental health impact of COVID-19," Jacobs said.
In the trial, 76 teenagers, ages 14â17, with a history of depression were randomly assigned to 10â14 sessions of RF-CBT, while controls were allowed and encouraged to receive any standard treatment. Teens reported ruminating significantly less if they received RF-CBT. Even more intriguing, fMRI illustrated shifts in brain connectivity, marking a change at the neural level.
Specifically, there was a reduction in the connection between the left posterior cingulate cortex and two other regions; the right inferior frontal gyrus and right inferior temporal gyrus. These zones, involved in self-referential thinking and emotional stimuli processing, respectively, suggest RF-CBT can enhance the brain's ability to shift out of the rumination habit. Notably, this work is a pre-registered replication; it demonstrates the same brain and clinical effects in the Utah sample in 2023 that was first reported in the Chicago sample in 2016.
"For the first time, this paper shows that the version of rumination-focused CBT we have developed at the University of Exeter leads to changes in connectivity in brain regions in adolescents with a history of depression relative to treatment as usual," Watkins said.
"This is exciting, as it suggests the CBT either helps patients to gain more effortless control over rumination or makes it less habitual. We urgently need new ways to reduce rumination in this group in order to Improve the mental health of our young people."
Next, the researchers will focus on demonstrating the efficacy of RF-CBT in a larger sample with an active treatment control, including continued work at Ohio State, Nationwide Children's Hospital, University of Exeter, University of Utah and the Utah Center for Evidence Based Treatment.
Future directions include bolstering access to teens in clinical settings and enhancing the ways we can learn about how this treatment helps youth with similar conditions.
"Our paper suggests a science-backed method to break the rumination cycle and reinforces the idea that it's never too late or too early to foster healthier mental habits. Our research team thanks the youths and families who participated in this study for their commitment and dedication to reducing the burden of depression through science and treatment, particularly during the challenges of a global pandemic," Langenecker said.
More information: Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial, Biological Psychiatry Global Open Science (2023). DOI: 10.1016/j.bpsgos.2023.08.012
Citation: Functional MRI study finds correlated shifts in brain connectivity associated with overthinking in adolescents (2023, October 27) retrieved 17 November 2023 from https://medicalxpress.com/news/2023-10-functional-mri-shifts-brain-overthinking.html
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Shrinkage of one of the brain's key memory centers appears to herald thinking declines, a new study finds.
The region in question is the hippocampus, a two-sided structure located roughly above each ear and embedded deep within the brain's temporal lobe. It's long been known to play a crucial role in the storage and transference of short- and long-term memory.
The new research was published Wednesday in the journal Neurology. It focused on brain scan data collected from 128 people averaging 72 years of age.
A team led by Dr. Bernard Hanseeuw, of Harvard Medical School in Boston, used the scans to track changes in brain levels of amyloid plaques or tau tangles. Both are linked to the onset of Alzheimer's disease.
The team also used the scans, which were taken annually, to chart any changes in the size of an individual's hippocampus over the course of seven years.
People who showed the most significant shrinkage in their hippocampus were also most likely to display thinking declines over the study period, Hanseeuw's group reported.
This seemed to occur independently of changes in levels of either amyloid or tau, they noted. They estimated that hippocampus shrinkage might account for 10% of thinking declines.
"These results suggest that neurodegenerative diseases other than Alzheimer's are contributing to this decline, and measuring the hippocampus volume may help us evaluate these causes that are currently difficult to measure," Hanseeuw said in a news release from the American Academy of Neurology.
"This could help us better predict who would respond to these new drugs as well as people's trajectories of cognitive decline," he reasoned.
Find out more about the brain and the hippocampus at Johns Hopkins Medicine.
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NEW YORK, Oct. 2, 2023
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