PEN eNews 10(5) May 2020

For the past two months, the PEN^® System has been Open Access to eliminate barriers to evidence-based nutrition as dietitians around the world abruptly shifted gears in response to COVID-19. More than 50,000 users accessed the PEN System during that time. That’s a 27% increase over the same time period last year! If you used the PEN System’s Open Access, please take 3 minutes to fill out a survey about your experience: https://www.surveymonkey.com/r/GLDSL7S.

Open Access to the entire PEN System is ending soon, but you can still access it here. We will continue to make COVID-19 information, Trending Topics and PEN^® eNews available with no PEN subscription or access credits required:

• COVID-19
  • COVID-19 and Nutrition Background
  • COVID-19 Related Tools and Resources
• Trending Topics 
• PEN^® eNews
  
  

If you are not a current PEN subscriber and you are interested in continuing your access to the entire PEN System, please view the different subscription options available at: https://www.pennutrition.com/signup.aspx. Revenue from PEN subscriptions is reinvested in the system to keep the content up-to-date and constantly growing while positioning you on the leading edge in your practice. The PEN System does not accept industry revenue or advertising.

We hope you'll be an active member of our PEN community and stay connected with us:

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 Stay Safe,

The PEN Team

Diabetes and B12 - What is the Latest?

What are the considerations related to vitamin B12 status in individuals with diabetes mellitus?

Individuals with diabetes mellitus who use metformin should have their vitamin B12 status monitored regularly due to an increased risk of vitamin B12 deficiency. Additionally, vitamin B12 deficiency should be ruled out as a cause of neuropathy in people with diabetes. It is unclear whether vitamin B12 supplementation should be routinely recommended to individuals taking metformin.

Individuals with type 1 diabetes are at an increased risk of developing pernicious anemia compared to the general population, although the risk is still relatively low. Individuals with type 1 diabetes who have symptoms of pernicious anemia should be screened; the utility of a screening protocol for asymptomatic individuals is unclear.

To see the related evidence and references, click here.

Did you know that the diabetes-specific content in the PEN^® System includes:

• 14 Knowledge Pathways
• 111 Practice Questions
• 69 Client Handouts
• 74 Professional Tools and Resources.

Occupational Allergy: Up-to-Date

The Allergic Disease - Occupational Knowledge Pathway was just updated. Click here to see the full knowledge pathway. Here are the recommendations related to foods that are likely to cause allergies due to occupational exposure:

Pregnancy - What’s New?  

 
There are five pregnancy PEN knowledge pathways in the PEN^® System:

• Pregnancy
• Pregnancy - Hypertension
• Pregnancy - Nausea and Vomiting/Hyperemesis Gravidarum
• Pregnancy - Multi-fetal
• Gestational Diabetes.

New and updated pregnancy content is always being added. Here is the latest:

What is the efficacy and safety of herbal medicines used for inducing or shortening labour?
What non-prescription therapies are effective for the treatment of nausea and vomiting in early pregnancy (first trimester)?
What herbal beverages/supplements are safe to take during pregnancy and lactation?
Is any amount of alcohol safe to consume during pregnancy?
Do infants with a parental history of allergy have a reduced incidence of allergy if their mothers avoid common allergenic foods during pregnancy as compared to infants of mothers who do not restrict their diets during pregnancy?
Pregnancy Practice Guidance Toolkit
Pregnancy Background
Pregnancy Summary of Recommendations and Evidence

Want to know what else is new and updated? Bookmark these pages:
New Knowledge Pathway Content
 (Knowledge Pathways, Practice Questions, Summary of Recommendations and Evidence, Practice Guidance Toolkits, Backgrounds)
Tools and Resources.

The PEN^® Team has years of experience working home-based, as that is our norm. Here are some tips we hope you will find helpful.

Routine

• Have a set schedule/routine and stick to it as best as you can. 
• Have a structured work time for your day. If you are full-time, start and end around the same time each day. If you are part-time, set a certain time of the day/week when you work.
• Discipline is needed for working from home. It can be easy to get distracted by domestic things (chores and people!). With a schedule/routine, it makes it easier to stay on track.
• A task list can help keep structure. Prepare your list for the next day before finishing work every night so that you start every day with a clear plan. 
• Schedule breaks using a timer - otherwise it's too easy to say "I need a break!" and then look at your phone for 1/2 hour without realizing it. Here is a favourite: https://tomato-timer.com/ 
• Changing out of pyjamas into regular day clothes in the morning is important. It is okay to wear yoga pants and leggings but try to avoid pyjamas unless you are still at the desk past 8 pm! 
• Dress in clothes so that you are ready to be on a video call - you just never know who it might be! For those who don't want to get dressed in 'business casual' every day, hang a blazer or nice sweater on the back of your office door or chair that you can throw on at a moment's notice! 
• For parents with young kids, waking up an hour or half hour before them to get ready and plan the day can be helpful.
• Without a routine, it can also be easy to get distracted by work and the domestic things don’t get done. It can depend on what you don’t like to do. Work can more fun than cleaning sometimes!
• Family and friends may make more contact with you during your work hours when you are in a home setting. Unless it is urgent, don't respond to personal calls or texts during your work hours, which keeps you focused and gives them the message that you are not available when working.

• Have a designated workspace if possible. A separate room with a door is ideal.
• Whether your home office is for a few weeks, a few months or longer, having an organized, ergonomic workspace that is personalized and inviting (i.e. decorated with favourite books, memorabilia, degrees/diploma, greenery!) is more comfortable.
• Invest in some house plants so that you have something to talk to, feed and water.
• If possible, don't use your office space for anything personal. It helps to separate home and personal worlds.
  
  

• Engage with colleagues through phone or video chat meetings.
• Sometimes scheduling meetings/conference calls is difficult to do with others as they have their own schedules/routines. Try to find a common time that is mutually agreeable. Be creative and flexible.
• Schedule regular virtual meetings with teams and start them with a check-in to see how everyone is doing before discussing business. It nice getting to know colleagues on a different level.

Physical Activity, Healthy Eating and Mental Health

• In your schedule/routine, include time for fitness/physical movement/fresh air breaks.
• Set a timer to go off every hour to make sure you remember to move.
• Set exercise breaks throughout the day and drink lots of water. 
• A midday exercise break is a great way to clear your head.
• Walk while you are talking on the phone or stand while you are listening to a podcast, webinar or in a virtual meeting.
• Get up and have breakfast at a regular time.
• Plan meals and try to keep them at typical times spread throughout the day. It is easy to snack too much!
• Invest in some high quality teas, coffee, espressos and good quality equipment and good water to prepare them, so that you have a source of joy and comfort.
• It is important to connect with others after work, particularly if you live alone. Schedule a time to email, call, video chat, etc. with a friend or family member every day.
• And finally, be kind to yourself. These are challenging times. Those of us who normally work home-based have had years of finding the best ways for doing so. It takes time for most of us to figure it out.

In April 2013, the PEN^® Team introduced the Practice Guidance Toolkits. These toolkits make the access to essential information on nutrition assessment, diagnosis, intervention, monitoring, associated tools and education materials based on nutrition-related conditions/diseases more 'up-front' and easier to retrieve. The toolkits present information in a format consistent with International Dietetics & Nutrition Terminology (IDNT) with direct access to succinct information that dietitians use in their practice. The toolkits are a stand-alone tool used primarily for clinical knowledge pathways and are included in the Summaries of Recommendation and Evidence.  

To find them on the PEN home page, click on the Toolkits icon that leads to all available toolkits. 

They can also be found on the Knowledge Pathways Table of Contents page. Click on any of the icons under the Practice Guidance Toolkit column. Alternatively, within a knowledge pathway, click on the “Toolkit “ tab on the right-hand side of the page. The Toolkit tab will only display as an option if the knowledge pathway has a toolkit.

Helpful Features in the Toolkits  

• Click on any of the items on the Table of Contents of the right-hand side of a toolkit to get quick, direct access to any section within the toolkit.  

• Flags! Where information is specific to a particular country, you have the option of seeing only your country’s information or viewing other’s information as well.  Simply click the box at the top of the page for the country information that you would like to view, and it will be displayed (or alternatively unclick the box to hide it).

Below is a list of toolkits that have recently been updated: 

• Cancer Practice Guidance Toolkit
• Rheumatoid Arthritis Practice Guidance Toolkit
• Diabetes - Glycemic Index Practice Guidance Toolkit
• Nervous System - Parkinson's Disease Practice Guidance Toolkit
• Diabetes - Nephropathy Practice Guidance Toolkit
• Pregnancy Practice Guidance Toolkit

Adapted from an April 2013 PEN eNews article.