Universitas Days 3 & 4

Malnutrition Screenings

I had the opportunity to accompany the fourth year students on a few malnutrition screenings in some of the wards on Wednesday morning. In order to screen for malnutrition in the adult patients, the students measure the mid-upper arm circumference, ulnar length, knee to foot length, and full arm length. They also took a skin fold measurement of the arm on both men and women (using the tricep). The last thing that they did was inquire about any recent weight loss, and if there had been weight loss, then they asked for the time period in which the weight has been lost. 

Surgery ICU

In the surgical ICU ward, not all patients require a special feed. Some of them are placed on tube feeds, but others are allowed to eat a normal oral diet. It is always important to check blood results before writing a patient's diet because some factors could be indicative of nutritional status--typically albumen (a water soluble protein) is a marker for nutritional status and diagnosis. Prealbumen is a most indicative marker for nutritional status, but it is not typically measured. It is also important to know a patient's kidney status before prescribing protein because too much protein in the body could place pressure and potentially cause damage to the kidneys. 

The most interesting thing that I learned about today is known as refeeding syndrome.The following link really helped me to understand a little more about it: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC390152/. 

"Starting to eat again after a period of prolonged starvation seemed to precipitate cardiac failure. The pathophysiology of refeeding syndrome has now been established.² In starvation the secretion of insulin is decreased in response to a reduced intake of carbohydrates. Instead fat and protein stores are catabolised to produce energy. This results in an intracellular loss of electrolytes, in particular phosphate. Malnourished patients' intracellular phosphate stores can be depleted despite normal serum phosphate concentrations. When they start to feed a sudden shift from fat to carbohydrate metabolism occurs and secretion of insulin increases. This stimulates cellular uptake of phosphate, which can lead to profound hypophosphataemia.³ This phenomenon usually occurs within four days of starting to feed again"

--Stephen D. Hearing

Multi-Disciplinary Team Meeting

Departments involved: psychology, physiology, dietetics, general practice, and social work.

This was a meeting held to discuss the "pain patients," those patients who have been admitted for chronic pain. It is a bit of a round table discussion put in place so that all doctors and other staff members assigned to these patients can help to fill the gaps in the patients' files. The team relies heavily on the Stages of Change model (precontemplation--contemplation--preparation--action--maintenance) to determine the patient's readiness and willingness to change and/or be helped in order to alleviate his or her pain. 

The most interesting thing that we discussed during this meeting was this small little piece of food for thought (may be a possible research study here!): Does working for a company that sells a certain product turn you off of that product (i.e. Does working for a fast food company turn you off of eating that company's food?). 

Despite all of the interesting things that I've learned this week, I think the biggest thing that I learned is that there is an obvious and distinct difference between public and private practices here. I think that Kalie may have mentioned this in one of her earlier blogs this week, but the difference that you see in the staff members is absolutely night and day. Those in the public practice are always moving to the next patient...not waiting to stay and talk to the patients, not trying to forge a relationship with them, but instead aiming to be efficient in their work and get as much done as possible. On the other hand, in the private sector, things move much slower. Staff members make an effort to get to know their patients and ensure that patients feel comfortable and satisfied before moving on to the next one. Social status is becoming more apparent and it has really opened my eyes to the differences in culture among ethnic groups in South Africa.