AuSPEN NEWSLETTER - JUNE 1999

AuSPEN NEWSLETTER
Number 2 : JUNE 1999

NEWS FROM COUNCIL

Council met in December, March and May with their next meeting scheduled for this month. A major item on their Agendas has been the forthcoming Annual Scientific Meeting. The full flyer for that meeting will soon be in the mail to all Members and it promises to be a very interesting programme - see the Calendar in this issue for greater details.

Council has accepted the following nominations for Membership of the Society; these will be forwarded to the next AGM for formal election to the Society.

Andrew Davies : ICU Specialist at the Alfred Hospital Penny Hillsman : ICU TPN Dietitian at St Vincent's Hospital
Elisabeth Frew : Dietitian at the Dandenong Hospital Marianne Chapman : Clinician at the RAH ICU
Megan Herriot : Dietitian at RAH Sheena Singh : Dietitian at RPA
Anne Marie Wilson : ICU Neurosurgery Services at RMH Victoria Crowder : Dietitian, Greenlane Hospital, NZ
Vicky Campbell : Manager of Nutrition Services, Waitemata Hospital, NZ Kylie Shanahan : Dietitian - Home Enteral Nutrition at Ballarat Hospital
Jan Rosewarne : Dietitian, NZ Luna Sarmiento : Pharmacist
Jacqueline Baily : Dietitian Christine Walsh : Baxter NSW
Sandra Cork : Baxter NSW Joy Blacka : Clinical Nurse Consultant, St George's Hospital
Melinda White : Dietitian, Royal Children's Hospital, Brisbane David Moore : Gastroenterologist, Women's and Children's Hospital, Adelaide
Roy Dennis : ICU Physician, Sydney Jodie Bennet : Dietitian, St George Hospital
Joanna Clark : Clinical Nurse Consultant, Royal North Shore Hospital

The Society now has a permanent Secretariat. This is in the early stages of being set up and can be contacted at 233, Rathdowne St., CARLTON. There is a combined number for contact, messages and fax : 03-9639-4677.

Members should have received the April and May 1999 Editions of Nutrition in fairly close succession. If you have not then please contact The Secretariat or Liliana Sputore, Honorary Secretary because there have been some delays and some issues may still be outstanding for some Members.


CONTACT ADDRESSES

Dr Julie Bines, President of AuSPEN, Dept. of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, MELBOURNE, Victoria 3000, Australia.
Ph +61-3-9345-5060. Fax +61-3-9345-6240
email bines@cryptic.rch.unimelb.edu.au

Liliana Sputore, Honorary Secretary of AuSPEN, 40 Jackson Avenue Karrinyup WA 6018.
Ph : +61-8-9445-3040, +61-8-94312769 Fax : +61-8-9446-4282
email : lili@tpgi.com.au

Sabita Rajeshwar, Honorary Treasurer of AuSPEN , Dept of Nutrition and Dietetics, The New Children's Hospital, PO Box 3515,Parramatta, NSW 2124
Ph +61-2-9845-2225 Fax +61-2-9845-2252 email Sabitar@nch.edu.au

Secretariat : 233, Rathdowne St., CARLTON. There is a combined number for contact, messages and fax : 03-9639-4677.




SYNTHETIC VITAMINS

Dr Tom Hartley

The current shortage of parenteral multivitamins rekindled my enthusiasm to investigate of some of the aspects of the contemporary 'vitamin market'. I am sure that I am not alone in taking the availability of vitamins for granted; you only have to walk into any health food shop to see the shelves bending under the weight of single and multi- vitamin supplments for oral use. So one would think that the constituent vitamins are widely available as individual items that can then be compunded into pills, solutions etc. Being a chemist my first point of call was to investigate availability in the 1999 Sigma Biochemicals and Reagents Catalogue. Sure enough every vitamin we are interested in is listed and most of them, ten out of thirteen are available as United States Pharmacopeia XXIII grade, (USP). These data revealed that there was a very wide range of costs per 25g as shown in Table 1. Most of the vitamins cost tens of dollars per 25 grams. However, Pyridoxine hydrochloride, Cholecalciferol and Ergocalciferol are worth hundreds of dollars per 25 grams and Cyanocobalamin and Biotin are distinguished by being worth a couple of thousand dollars per 25 grams. (All prices in the Table are in Australian dollars.)

Vitamin D2 Ergocalciferol Not USP $602
Vitamin D3 Cholecalciferol USP grade $743
Vitamin E Alpha-Tocopherol Not USP $29
Vitamin K3 Menadione USP grade $28
Vitamin C Ascorbic Acid USP grade $34
Thiamin (B1) USP grade $44
Riboflavin (B2) Riboflavin 5'-phosphate USP grade $28
Niacin (B3) Nicotinic Acid USP grade $67
Pantothenic Acid (B4) Sodium salt Not USP $20
Pyridoxine (B6) Hydrochloride USP grade $265
Cynanocobalamin Vitamin B12 USP grade $2164
Biotin USP grade $2032
Folic Acid USP grade $88

Another major manufacturer of vitamins is BASF. BASF is a multinational company that originated from a soda and dyestuffs manufacturer called Badishe Anilin- und Soda Fabrick in Mannheim, Germany, that dates back to 1865. Their US web site - www.basf.com - provided the information that they have seven vitamin manufacturing sites worldwide and their German website - www.basf.de - had a lot of detail on the vitamin products themselves eg pharmacopeia compliance, physical formulation etc. but no indications on pricing.

The next question was : are these vitamins manufactured or extracted from natural products ? It soon became apparent from looking into the Merck Index that it was pointless to try and even generalise - there are extraction and synthetic routes to them all and there was no indication as to which was the most modern and commercially preferred route. So I tried an alternative approach - were there production statistics available for vitamin production ? Not directly but there was an internet site - www.nutritionfarm.com - which produced the following staggering USA annual consumption statistic : in 1998 one hundred million Americans spent $6.5 billion on vitamin and mineral pills and potions. Intensive animal farming operations also consume large amounts of dietary supplements including vitamins. Additional data from the BASF Annual Report for 1998 showed that their Health and Nutrition Sector showed a an 11% increase in sales in contrast to all their other divisions - colorants, chemicals, plastics, fuels, miscellaneous - which all showed downturns in income. Clearly there are huge demands for Health and Nutrition related chemicals all driven by growing demands from both the human nutrition and animal nutrition sectors which in turn place significant demands upon the vitamin production industry.







NEWSLETTER SPONSOR

This issue of the Newsletter has been generously sponsored by : Alison Missen and BAPEN - The British Association for Parenteral and Enteral Nutrition. Plans are underway to hold a BAPEN Course in New Zealand this year - see the insert with this Newsletter and the Calendar of Meetings.




RECENT DEVELOPMENTS IN THE CARE AND MAINTENANCE OF CENTRAL VENOUS ACCESS

Sarah Breier,


TPN Clinical Nurse Specialist, Royal Hobart Hospital

As with any interruption in skin integrity, CVC insertion places the patient at risk of infection. The preparation of the skin prior to, and the management of the insertion site following CVC placements remains a controversial aspect of patient management1,2. At the Royal Hobart Hospital, it was noted at the end of 1997 that the approach to CVC site management varied immensely between departments. Approaches ranged from utilizing various antiseptic solutions including povidone-iodine (solution and ointment), chlorhexidine 0.5% in alcohol 70%, and chlorhexidine 0.05% and centrimide 0.5% aqueous. Dressings routinely remained intact for a maximum time elapse of 96 hours. The choice of antiseptic for cleansing prior to insertion and maintenance of the site thereafter did not actually reflect best practice as such, but simply practitioner preference and solution availability. As a joint initiative between the Department of Critical Care Medicine and Infection Control, it was decided to review CVC maintenance by revisiting the related clinical literature regarding CVC infection control, and implementing a product evaluation trial of a new dressing product i.e. the Biopatch® by Johnson & Johnson.

Biopatch® contains a topical antimicrobial chlorhexidine gluconate in sustained release formation. Following application, approximately 25% of initial CHG loading is released, with a further slow release of maintenance CHG over seven days 3. The sustained release formulation is contained in a 2.5-cm hydrophilic polyurethane absorptive foam disc which can absorb up to eight times its own weight4. The Biopatch® and chlorhexidine approach was applied in the critical care setting whereas those CVC's maintained by povidone-iodine were inserted and maintained in other areas of the RHH, primarily the adult medical and surgical wards. Patients who were 'Biopatched' required the placement of intermittent non-tunneled multiple lumen CVC's for fluid resuscitation and maximum haemodilution for inotropic medications and/or total parenteral nutrition.

Product Evaluation

The aim of this trial was to evaluate the efficacy, ease of use, cost and incidence of catheter related infection associated with the use of controlled release chlorhexidine gluconate dressings (Biopatch®) for central venous catheter (CVC) sites compared to those maintained by povidone-iodine solution and ointment.

Method

60 patients with CVC's inserted and maintained with povidone-iodine outside of the critical care setting in a 6 month period (June-Dec 1998) were compared to 60 patients whose CVC's were inserted and maintained with Alcohol 70% and Chlorhexidine 0.5% plus Biopatch® in the Department of Critical Care Medicine over the same time period.

Biopatch® Group: 0.5% chlorhexidine in Alcohol 70% solution prep prior to insertion and cleansing with the same at dressing changes thereafter. Biopatch® disc applied to around the CVC as per manufacturer's instructions. Site occluded with semipermeable membrane dressing. Dressing change performed every 72-96 hours.

Povidone-iodine Group: Povidone-iodine solution prep prior to insertion and cleansing with the same at dressing changes thereafter. Povidone-iodine ointment applied to insertion site. Dressing change performed every 72-96 hours.

Results

Biopatch® Group: Nil of the 60 patients was observed to culture a positive CVC tip.

Povidone-iodine Group: 14 out of 60 patients' CVC tips cultured the following organisms in this group:

Staphylococcus warneri 1
Staphylococcus epidermidis 5
Staphylococcus stimulans 1
Klebsiella pneumoniae 2
Enterococcus faecalis 2
Staph coag neg diptheri 1
Staph coag neg strep species 1
Pseudomonas aeruginosa 1
Comparison of Groups

The number of infectious complications in the povidone-iodine group were 23% higher than the Biopatch® group. One patient in the povidone-iodine group was observed to have a local reaction to the povidone-iodine solution. There was no local reaction observed in the Biopatch® group.

Scarring post CVC removal (by subjective assessment) was notably less prominent in the Biopatch® group than the povidone-iodine group. A 'lip' of scar tissue was commonly observed to those CVC insertion sites prior to and after removal with the povidone-iodine group. This also, was the first reaction of those RN's working in the Department of Critical Care Medicine when they removed the first of the Biopatches, i.e., how clean and 'flat' they appeared. Nursing staff using the Biopatches commented on their ease of use, and also of their excellent absorption and additional support to the CVC thereby reducing catheter movement.

Costs between the groups were compared. Povidone-iodine solution is marginally more expensive than chlorhexidine/alcohol solution, i.e. $2.30 and $2.10 respectively. The Biopatch® works out to cost 20 cents per day whereas the povidone-iodine solution is only 5 cents per day. These costings have been estimated by product cost per unit divided over a 96-hour maximum time lapse for dressing change.

Implications for Practice

Despite being marginally more expensive per unit than the povidone-iodine approach, the money saved in additional treatment and care for patients sustaining catheter related infectious complications is by far the most significant financial gain of utilizing the Biopatch® approach. The dressings are easy to use, provide excellent absorption and reduce the number of unscheduled dressing changes. Additional benefits noted by the users included being non-toxic and non-irritating. This positive report opens up other opportunities for improved cutaneous antisepsis with other device management in the hospital, for example:

References

1. Maki, D., Ringer., & Alvarado, C. 1991, Prospective Randomized Trial of Povidone-Iodine, Alcohol and Chlorhexidine for Prevention of Infections Associated with Central Venous Catheters and Arterial Catheters, Lancet, 238: 339-343.

2. Maki, D. G. Nosocomial Bacteria - an Epidemiological Overview, American Journal of Medicine, 70: 719-732.

3. Schapiro, J.M., Bond, E.J. & Garman, K. Use of Chlorhexidine Dressing to Reduce Microbial Colonization of Epidural catheters, Anaesthesiology, 73 (4): 2396-2403.

4. Johnson & Johnson Medical, Inc. Arlington, TX. Data File.



META ANALYSIS AND EXPERT SYSTEMS

Dr Tom Hartley

One of the features of the 1998 Annual Scientific Meeting was that many of our invited speakers referred to 'Meta Analyses' of previously published work particularly in relation to the great debates over early enteral nutrition versus parenteral nutrition and glutamine and nucleotide supplemented enteral feeds versus the standard feeds. The concept is that by pooling information from a number of literature reports larger numbers of patients are effectively put into the 'study group' and the 'control group' which in turn leads to greater statistical power of the 'composite study'.

What makes a Meta Analysis different from the 'Review Article' ? Essentially they are more formalised and disciplined analyses of published data. If you browse through almost any issue of the BMJ you will find that they are consistent reporters of Meta Analyses. The 'evidence based medicine' fraternity are also great proponents of meta analyses. Certainly the papers by Egger et al (BMJ Nos 7119 and 7121, November & December 1997) give accounts of the method but probably the website at McMaster University in Canada has the most systematic explanations; www.hiru.mcmaster.ca. They point out that the method is best carried out by two or more reviewers who before they even start make some very unambigous criteria for firstly including reports and then secondly for assessing them. In their assessments of published meta analyses they ask the questions :

In my opinion the proponents of Meta Analysis have many of the same aims and objectives of the evidence based medicine fraternity. Overall they produce guidelines on diagnosis and clinical interventions for use by those of us who do not have as great a breadth of experience as the authors. This brings me to move on to consider computerised Expert Systems and the parallels that can be drawn between them and Meta Analysis and Evidence Based Medicine. For me the attraction of the Expert Systems is that they are more responsive to the user than are these two essentially document based tools - (and also have been around a lot longer than either of these current 'buzz words' !). Well regarded Clinical Specialists provide 'reference panels' of clinical histories to the designers of Expert Systems. These form the reference database against which other clinicians can have their 'undiagnosed' cases interpreted. Ongoing refinement of the knowledge base is achieved by adding more 'accredited' clinical histories to the database. So the more the Expert System is used theoretically the smarter it gets. A feature of the Expert System publications is that there is very careful attention to the definition and categorisation of clinical information. The language we use to describe our clinical observations and clinical interventions are fundamental to this whole process of dignosis and treatment. So it is not surprising to find that there is an evolving 'Unified Medical Language System', UMLS,

(see www.cpmc.columbia.edu/homepages/ciminoj/pubs/meth-95.html }.

This article by Cimimno refers to the UMLS Semantic Network for classifying medical concepts and inter-concept relations and a Metathesaurus to serve as a repository for bringing together concepts from disparate controlled vocabularies. His project has been to explore the feasibility of using the UMLS to descibe clinical cases. UMLS was developed primarily to facilitate computerised access to the clinical literature not to describe clinical cases. However since much of the clinical literature consists of clinical case reports then the hypothesis is that the UMLS should be useable in reverse ie. to provide the language for a Clinical Information System. He concludes that this is feasible via the controlling influence of a Medical Entities Dictionary. Interestingly and not surprisingly his work was funded by the US National Library of Medicine and the IBM Corporation.

A couple of practical examples of what is going on here might help at this point. This example is taken from a chapter by Chytil (in Medical Expert Systems Using Personal Computers, published by Sigma UK, (1987)) where he discusses data analysis and metadata analysis. His example centres on a simple and very typical data table :

Sex
Age
Occupation
Lives alone
Heart attack as checked by a doctor
Angina Pectoris
Diabetes Mellitus
Raised Choesterol
Blood Pressure
Pacemaker
Family history of Heart Attacks
Heavy smoker
ECG normal
Blood Pressure Normal
Number of Heart Attacks

Most of us would not appreciate that for each row's title the data content can be classified according to seven Metavariables each of which has its own range. For example Sex is either male or female and is therefore described syntactically as being Boolean; (as per Boolean Logic - something is either true or false, there are only two possibilities). Semantically Sex is a descriptive earmark . It has a degree of standadisation that is generally recognised as standard. The data on Sex has its origin from a doctor / patient interview . It's degree of incompleteness is such that missing values do occur. It's SNOMED Code does not exist and it's plausibility is high

In comparison a laboratory measurement such as the serum cholesterol and its classification as being high is syntactically boolean, semantically a side effect of the underlying disease, has a high degree of standardisation, has its origin deduced from another source - the lab. report, its degree of incompleteness is such that erroneous values can occur, it has a SNOMED code relating to the aetiology of heart disease, and it's plausibility is high.

Essentially this type of analytic approach enables you to take very uncompromising views of data tables particularly when the authors make no suggestions as to the actual quality of the data collection as it applies to each row.

Here is the full list of the Metavariables and the scope that they can take that Chytil considered in his example. One would probably adjust the scopes that they can take so that they become more approprite for the data you are considering

Some articles do make a very clear point of assessing the quality of the data rows. Take for example Table III in the article by Novy and Schwarz (Nutrition, Vol 13, #3, p 180, March 1997):

Evaluation of Nutritional Assessment Parameters in Childhood Liver Disease
Valuable
Misleading
Body Weight
*
Height
*
Upper Extremity Antropometrics
*
Lower Extremity Antropometrics
*
Plasma Proteins
*
Nitrogen Balance Studies
*
Creatinine / Height Index
*
Immune Status
*
Subjective Assessment
*
24 Hour Dietary Recall
*

In the same issue of Nutrition Morgan et al describe their experience with the use of an Expert System for the prescription of enteral formula; (Nutrition, Vol 13, #3, p 196, March 1997). Unfortunately they do not give a reference as to how the Expert System - called Enteralfit - was built. Of particular interest would be the knowledge base that is founded upon. A good idea of what was considered can be gathered from the questions the authors answered before inputing the data into the computer program :

They were then able to compare the prescription produced by the Expert System with those prescribed by the Ward Team. Looking at these twenty two data fields in is interesting to consider them from the point of view of the Metavariables concept described earlier. Very many of them, 14 out of 22 - are Syntactically Boolean and so the questionnaire is very much a decision tree type of approach. Interestingly many of these Boolean decisions are based on Degrees which are standards they have tailored to their own study eg cholesterol >= 5.2 mmol/L and PCO2 => 50 mm. So if you were going to use this paper in a Meta Analysis you would have to rate its value as being less than a paper that used Degrees that were bound to recognised standards for these parameters. The opportunity for a number of variables to have a high degree of Incompleteness was quite significant in relation to the variables gleaned from the medical record eg. malabsorption, liver failure, congestive heart failure, fluid restricted etc. And so you can go on through their Table and make some quite rigorous decisions about the qualities of the data they collected.

So hopefully this sorti into the world of Meta Analysis has illuminated some of its machinations and make one regard data in Tables as not so much information 'that is either black or white' but more information that have foundations which range from the 'very good' to the 'just about plausible'.




CALENDAR OF NATIONAL AND INTERNATIONAL MEETINGS

June 17th - 19th, 1999 : Eighth European Nutrition Conference , Lillehammer, Norway. Sponsored by the Norwegian Nutrition Society, Federation of European Nutrition Societies, and the European Academy of Nutritional Sciences. Contact Lillehammer Arrangement AS, PO Box 14, N-2601 Lillehammer, Norway. Ph +47-61-251705. Fax +47-61-256515.
email: lillarra@sn.no Webpage :www.nutrition.uio.no/nse/8thFENS_EANS

July 23rd - 27th 1999 : XIII International Congress of Dietetics  Edinburgh International Conference Centre, Scotland, United Kingdom. Contact: Vicki Grant and Wendy Adesegun, c/o Meeting Makers, 50 George Street, Glasgow, G1 1QE, Scotland, United Kingdom. Tel: 44 141 553 1930; Fax: 44 141 552 0511; or
e-mail: mm@meetingmakers.co.uk

August 8th - 12th : VII Congress Latin American Society of Parenteral and Enteral Nutrition  Hotel Herradura Resort and Conference Center, San Jose, Costa Rica. For more information: Tel: 506-236-4432 382-9816; Fax: 506-235-9313; or
e-mail: mpiza@nacion.co.cr

September 4th - 8th, 1999 : 21st ESPEN Congress , Stockholm, Sweden. Abstracts are due by 22nd March 1999. Local Organising Committee : Ms Helene Jansson, Dept of Surgery, Huddinge University Hospital, SE-141 86 Huddinge, Sweden. Ph +46-858-582431 Fax + 46-858-582340
email helene.jansson@karo.ki.se
Secretariat : ESPEN 99, c/o MCI Congress, 75 rue de Lyon, CH-1211, GENEVA 13 - SWITZERLAND. Ph +41-22-345-3600 Fax +41-22-340-2363,
email : chantal@mcitravel.com

Programme Outline :

September 22nd - 25th : The Tenth Clinical Congress of the Mexican Association for Parenteral and Enteral Nutrition (AMAEE) Marriot Casa Magna Puerto Vallarta Hotel, Puerto Vallarta, Jalisco, Mexico. For registration info: email : amaee@data.net.mx or fax: 525-559-4793. For accommodation info: Humboldt Tours, email : humbtours@iserve.net.mx or fax: 525-660-0735. Web site: www.humboldttours.com

September 27th -29th : South African Society of Parenteral & Enteral Nutrition (SASPEN) : Holiday Inn - Durban South Africa For more information contact: Jane Downs Website : http://www.saspen.com This is a good site and has the complete programme details.

October 7th - 9th, 1999 : International Symposium on in vivo Body Composition Studies, Brookhaven National Laboratory, Upton, NY. Contact S Yasumura, Bldg 490, Medical Department, PO Box 5000, Brookhaven National Laboratory, Upton, NY 11973-5000. Ph +1-516-344-3606. Fax +1-516-344-5311.
email: yasumura@bnl.gov.

October 18th - 21st, 1999 : The American Dietetic Association Annual Meeting and Exhibition, Georgia World Congress Center, Atlanta. Contact The American Dietetic Association, 216 West Jackson Boulevard, Chicago, IL 60606-6995. Ph +1-800-877-1600, ext 4866. Fax +1-312-899-0008.
email: mtgsinfo@eatright.org Webpage : www.eatright.org

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October 22nd - 23rd, 1999 : ANNUAL SCIENTIFIC MEETING OF THE AUSTRALIAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION. GOLD COAST INTERNATIONAL HOTEL, SURFERS PARADISE, QUEENSLAND.

Programme Overview

  • Oxidative Stress and Gastrointestinal Disease
  • Nutritional Assessment
  • Nutrition and Gastrointestinal Disease
  • Mucosal Nutrition
  • Pharmaceutical Aspects of Nutritional Support
  • Diet and Nutrition in Gastrointestinal Cancer
  • Workshop on Practical Issues of Nutritional Support

International Guests

  • Dr Khursheed Jeejeebhouy MD, Professor of Medicine, Nutrition and Physiology, University of Toronto and Director of the Nutrition Support Service, St Michaels's Hospital, Toronto, who has a distinguished career in gastroenterology and nutrition.
  • Dr John McFie MD, Consultant Surgeon at Scarborough Hospital, UK. His areas of expertise are in nutrition and mucosal immunity and the role of glutamine in nutrional support.

Conference Secretariat :
Consult Fleetwood, PO Box 79, ARANA HILLS, QUEENSLAND 4054, Australia.
Ph: +61-7-3264-5970 Fax: +61-7-3264-3520
email : charlesf@gil.com.au

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November 9th - 12th, 1999 : 1999 BAPEN Course Contact Alison Missen, Dietitian, Middlemore Hospital, Private Bag 93311, Otahuhu, AUCKLAND, NEW ZEALAND. Phone : Middlemore Hospital +64-9-276-0000 or Nutrition Services Dept +64-9-276-0090
email : amissen@middlemore.co.nz

November 25th - 28th, 1999 : Australian Society of Hospital Pharmacists Perth W.A. Contact Jenny Dyer, Motive Conventions, Perth, Western Australia. Phone: + 61-8-9322-2666 Fax: 61-8-9322-1417
email: motive@vianet.net.au
Topics : Allergic disorders, Anaesthesia, Cardiovascular disorders, Clinical pharmacology, Endocrine disorders, Gastrointestinal disorders, General Medicine, Health care management, Infectious and parasitic diseases, Musculoskeletal and connective tissue disorders, Neurologic disorders, Nursing, Nutritional and metabolic disorders, Paediatrics, Pulmonary disorders, Radiology, Sexually related disorders, Surgery, Transplant Surgery

2000

January 23rd -26th 2000 :  24th A.S.P.E.N. Clinical Congress , Opryland Hotel, Nashville, TN email: aspen@nutr.org

October 16th -19th 2000 : The American Dietetic Association Annual Meeting and Exhibition  Colorado Convention Center-Denver, CO. Contact: The American Dietetic Association, 216 West Jackson Boulevard, Chicago, IL 60606-6995. Tel: 312-899-0040; email: mtgsinfo@eatright.org or Website: http://www.eatright.org. Exhibit information contact: Lisa Nicola, 800-877-1600, ext. 4755. Attendee information contact: Frances Jennings, 800-877- 1600, ext. 4866. 






INTERNET NEWS

Keeping in touch via email became an issue during May while I was on leave in the UK and Japan. Initially I thought that I would use Hotmail, which is one of the most popular free email services you can access via an Internet Browser. However, when I logged in to set up an account it was impossible for me to get the email name I wanted; all the variations of hartley plus my initials or given name appeared to already be in use ! So I abandoned Hotmail and then tried Excite. They provide a very similar free service and I was able to get the email name I wanted tfhartley@excite.com. The mailer that Excite have set up has all the features you would like to have in an email program, a good message editor, the capacity to attach 'attachment' files, a generous amount of disk space on which to store your mail, the facility to store read and sent mail in folders that you can name and organise yourself and the feature to configure it to check email in up to three other of your email accounts. This is what is called a 'multi POP' feature. Essentially you provide your user name, internet address and password for those other accounts and as and when you wish you can go and check for email in them. Of course you can only read the mail from those other accounts. If you choose to answer them then of course your reply will appear to originate from the Excite or Hotmail account unless you take the effort to adjust the return address appropriately. It could easily slip your mind to do this with the result that your correspondent may get a bit confused that you appear to be replying from a different mail address. I have different email accounts for different activities and avoid sending messages from the inappropriate mailer. Certainly I would not recommend that you use a 'public email provider account' such as Hotmail or Excite for sending confidential data; no email account is confidential and I work on the presumption that these public mail services are less secure than your hospital, university or local internet service provider.

Most of us will have seen that the capital airports in Australia have Internet Booths where for $2 you can get 10 minutes of connect time. To be realistic you actually need a minimum of 30 minutes because the browser based email accounts are considerably slower than what you will have been used too at home or at work.

Now to my travels. In the UK I tried looking up Internet Cafes in the Yellow Pages but usually drew a blank. I soon learnt that the best way was to phone the local Library and they could give you details on their services as well as what was available as internet cafes in the locality. In this way I found that Colchester in Essex had a number of public internet acces points - but most were booked up for three days or more in advance! The local internet cafe, however, had five PCs which were usually available at short notice for about $7 per half hour. The Central Library in Manchester had an impressive array of 20 PCs for free access to local ratepayers. Within a few metres of that Library was also an Internet Cafe offering half hour sessions for $6. In Harrogate, Yorkshire, a local PC store directed me to an internet cafe charging $8 per half hour. So as far as the UK goes the secret seems to be to enquire at the libraries and computer stores. That way you can easily keep in contact with family and colleagues. After the UK I moved on to Japan, a country that I continue to enjoy visiting if only because of the extreme ease in which you can travel around plus the culture plus the tremendous challenge there is in trying to read Kanji. When I left the UK I essentially signed off on my email and was going to be out of contact for a week. There was no way that my Japanese was going to be up to finding internet cafes etc. But to my amazement I was walking through Sendai, which is a city 350 kms east of Tokyo, when I saw a sign which had the word Internet on it. It took me five minutes to work it all out - there was an internet bureau on the 4th floor of this office block offering 10 minutes for 100 yen. I ventured in and found an office where they spoke next to no English but had three internet PCs. I spent a hilarious fifty minutes there using Internet Explorer where the Toolbar etc. was all in Kanji but mercifully the keyboard produced Roman letters. Needless to say I sent a number of emails to prove the achievemnt. So I can thoroughly recommend Excite email for your next foreign jaunt - it can keep you in touch, you meet a lot of interesting people and it could even mean that those Power Point slides that were not all ready or quite right when you left Australia can be picked at a local cafe or library up as an attachment to an email from your long suffering Secretary or Clinical Photography Department back in OZ. Who says there are deadlines for abstracts and papers which cannot be bent to such extremes ?

____________________________________________


Some Health related sites noticed recently :

  • Ozzieweb Health : requires Internet Explorer 4 or above to access satisfactorily : www.ozzieweb.net.au/health/
  • Autralian E-Medical Services Directory : www.cundle.com.au/medindex.html




DISCLAIMER

The views and opinions expressed in this Newsletter are not necessarily the views and opinions of the Australian Society of Parenteral and Enteral Nutrition. Reports and articles on techniques, procedures and products are provided for the information of the Members of the Society and their inclusion does not imply any endorsements from the Australian Society of Parenteral and Enteral Nutrition. No liability can or will be accepted by AuSPEN or its agents for the third party use of information in this Newsletter.

Dr Tom Hartley, Editor, 16th June 1999.


Newsletter of the Australian Society for Parenteral and Enteral Nutrition
Editor : Dr Tom Hartley, 36, Pregnells Road, Sandfly, Tasmania 7150, Australia

Ph 03-6239-6475 (AH) 03-6222-8780 (BH) Fax 03-6231-3145
email hartley@southcom.com.au

AuSPEN WWW Homepage : www.southcom.com.au/~hartley/home.htm