TABLE OF CONTENTS
2	Editor’s Perspective M. Patricia Fuhrman, MS, RD, FADA, CNSD In the current evidence-based medicine environment, it is appalling that only 55% of United States patients are receiving evidence-based care (1). Those of us who want to provide evidence-based nutrition care may be struggling trying to identify what articles and publications provide the best science on which to change practice. Evaluation of the scientific literature for validity in your patient population is not always easy. This issue of Support Line addresses nutrition support conundrums, areas of nutrition support that have some scientific support for clinical practice, but not enough to provide evidence-based recommendations
2	Chair’s Column Ainsley Malone, MS, RD, CNSD How many of you have embarked on a project, initiative, or assignment in which immediate results were not realized? I am sure many of you have experienced this in both your practice and perhaps your personal life. How exciting it is to begin to realize the fruits of your endeavors, when that specific project is complete and the desired outcome has been achieved.
3	Lipids and Immunosuppression Cheryl Thompson, PhD, RD, CNSD , Mary Russell, MS, RD, CNSD Lipids provide essential fatty acids (EFAs) and a concentrated energy source to patients who require nutrition support. Fatty acids (FAs) are readily incorporated into cell membranes, which serve as a reservoir of FAs. The FA composition of the cell membrane has a significant effect on the function of enzymes and membrane-associated receptors. The type and quantity of FAs consumed can alter metabolic and immune responses during critical illness and in cardiovascular, gastrointestinal, pulmonary, and autoimmune disorders. The potentially detrimental effects of lipids on immune function can be managed most effectively when the clinician is fully aware of the consequences of providing inadequate, excessive, or inappropriate types of lipids.
8	Arginine and Wound Healing Marsha R. Stieber, MSA, RD, CNSD Arginine and its relationship to wound healing has been a topic of much research over the past 30+ years, primarily in acute wounds in rodent models. Despite such attention, clear and definitive guidelines for its safe and effective use in both acute and chronic wounds in humans in a variety of physiologic conditions have yet to be established.
17	Assessing Trace Element Status in Adult Long-term Parenteral Nutrition Patients Therese Austin, MS, RD, CNSD , Cynthia Hamilton, MS, RD, CNSD Patients who rely on parenteral nutrition (PN) for maintenance of their nutritional status need trace elements as part of their daily infusion. Trace elements are micronutrients required by the body in very small amounts to perform many vital functions. PN trace element recommendations were made by the American Medical Association Nutrition Advisory Group nearly 30 years ago, and manufacturers of intravenous trace element preparations have not altered the preparations since that time. Several case reports in the literature and a recent study indicate that the use of current trace element preparations can lead to deficiencies and toxicities. This article reviews the various functions of trace elements commonly used in PN solutions, outlines the daily adult requirements, and discusses reports in the literature of trace element abnormalities. In addition, indices used for monitoring trace element adequacy, including laboratory tests and assessment of physical signs and symptoms, are discussed.
23	Evidence-based Protocols: Why Protocols are Beneficial and Considerations for Implementation Susan Roberts, MS, RD, CNSD Evidence-based protocols are becoming more prevalent in health care due to increased concentration on patient safety, improvement of important patient outcomes, and cost containment. Some clinicians are reluctant to adopt protocols because of the perception that they take away the clinician’s autonomy and clinical judgment. Protocol implementation can result in positive patient outcomes but requires multidisciplinary collaboration and ongoing monitoring, while factoring in facility resources to ensure success and compliance.
26	What’s New at www.DNSDPG.org? Pamela Charney, PhD, RD, CNSD The DNS Web team is proud to be among the first dietetic practice groups (DPGs) to offer completely online continuing professional education credit for DNS members. One of the most popular areas of the DNS Web site is the Support Line section, where we have an archive of back issues, links to continuing education quizzes, and contact information for Support Line staff.
27	Supporting Dietetic Research Through the ADA Foundation Opens Doors in the Nutrition Profession DNSDPG All nutrition information is not created equal, and it can be hard for the public to sift through the ocean of data to find the pearls. This is why it is important to continue to support the American Dietetic Association (ADA) in its research mission.

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Viewpoints and statements in these materials do not necessarily reflect the policies and/or official positions of The American Dietetic Association or DNS.

SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual non-member subscriptions, $120 for institutions per year (plus postage surcharges for international subscriptions). Newsletter subscriptions are available to interested parties who are ineligible for ADA membership. Published by Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association (ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. Send requests for subscriptions to Jamie Diamond, MS, RD, CNSD, 3850 Galt Ocean Drive, Apt. 2009, Fort Lauderdale, FL 33308. For address changes: Please submit name and address changes directly to the Membership Team of the American Dietetic Association using the address change card in the Journal of the American Dietetic Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and Allied Health Literature.

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