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Burton-Obanla AA, Sloane S, Koester B, Gundersen C, Fiese BH, Arthur AE. Oncology registered dietitian nutritionists' knowledge, attitudes and practices related to food insecurity among cancer patients: a qualitative study. J Acad Nutr Diet 2021; 122:2267-2287. [PMID: 34896629 DOI: 10.1016/j.jand.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding the knowledge, attitudes and practices pertaining to food insecurity among oncology Registered Dietitian Nutritionists (RDNs) is critical to ensuring that cancer survivors have adequate nutrition-a fundamental component of successful treatment and recovery. OBJECTIVE To qualitatively assess Oncology RDN's knowledge, attitudes and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis. DESIGN The qualitative cross-sectional study was conducted from September 2018 to January 2019. PARTICIPANTS/SETTING Forty-one oncology RDNs working with cancer survivors in various clinical settings across the U.S participated. MAIN OUTCOME MEASURES Participants completed a semi-structured, in-depth interview via telephone, lasting an average of 49 minutes. STATISTICAL ANALYSES PERFORMED Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program, Dedoose, was used to organize and analyze the data. RESULTS Participants defined FI as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the U.S., has a greater impact on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs. CONCLUSIONS While Oncology RDNs have heard of FI, they do not routinely assess patients' food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs in order to enhance their ability to screen for and address FI with their patients.
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Luo X, Yan C, Zhang Y, Lu W, Feng Y. Comment on "Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis". Clin Nutr 2021; 40:5660-5661. [PMID: 34742135 DOI: 10.1016/j.clnu.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022]
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Jones M, Eggett D, Bellini SG, Williams P, Patten EV. Patient-centered care: Dietitians' perspectives and experiences. PATIENT EDUCATION AND COUNSELING 2021; 104:2724-2731. [PMID: 33926810 DOI: 10.1016/j.pec.2021.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/11/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To (1) explore RDNs' descriptions of patient-centered care (PCC), (2) measure Registered Dietitian Nutritionists' (RDNs) preferences for PCC and (3) identify factors that affect RDNs' PCC preferences. METHODS A survey instrument including two open-ended items exploring RDN descriptions of and experiences with PCC, the Patient-Practitioner Orientation Scale (PPOS), and various factors that could influence PCC (e.g., work intensification, work engagement, and work/demographic characteristics) was expert reviewed, pilot tested, and distributed electronically to 4697 RDNs. A regression analysis was conducted, and two open-ended items were qualitatively analyzed. RESULTS Three themes emerged when RDNs described PCC (n = 375): dietitian/patient relationship (95.7%), organizational influence (64.4%), and interprofessional teams (26.3%). RDNs (n = 318) scored 4.60/6 on the PPOS. Higher levels of work engagement were predictive of higher PPOS scores, and heavier workloads were predictive of lower PPOS scores (p < 0.05). Primary work position also influenced PPOS scores (p<0.05). CONCLUSION RDNs have varying personal definitions of and experiences with PCC, however there are common themes. RDNs generally prefer PCC and score moderately high on the PPOS. PRACTICE IMPLICATIONS To strengthen preferences for PCC, managers should create manageable workloads and prioritize work engagement. Continued emphasis on interprofessional collaboration with and organizational promotion of RDNs could improve PCC.
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Mattavelli E, Catapano AL, Baragetti A. Molecular Immune-Inflammatory Connections between Dietary Fats and Atherosclerotic Cardiovascular Disease: Which Translation into Clinics? Nutrients 2021; 13:3768. [PMID: 34836026 PMCID: PMC8625932 DOI: 10.3390/nu13113768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Current guidelines recommend reducing the daily intake of dietary fats for the prevention of ischemic cardiovascular diseases (CVDs). Avoiding saturated fats while increasing the intake of mono- or polyunsaturated fatty acids has been for long time the cornerstone of dietary approaches in cardiovascular prevention, mainly due to the metabolic effects of these molecules. However, recently, this approach has been critically revised. The experimental evidence, in fact, supports the concept that the pro- or anti-inflammatory potential of different dietary fats contributes to atherogenic or anti-atherogenic cellular and molecular processes beyond (or in addition to) their metabolic effects. All these aspects are hardly translatable into clinics when trying to find connections between the pro-/anti-inflammatory potential of dietary lipids and their effects on CVD outcomes. Interventional trials, although providing stronger potential for causal inference, are typically small sample-sized, and they have short follow-up, noncompliance, and high attrition rates. Besides, observational studies are confounded by a number of variables and the quantification of dietary intakes is far from optimal. A better understanding of the anatomic and physiological barriers for the absorption and the players involved in the metabolism of dietary lipids (e.g., gut microbiota) might be an alternative strategy in the attempt to provide a first step towards a personalized dietary approach in CVD prevention.
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Erratum for: "Dietetic and lifestyle recommendations for stone formers." (Arch. Esp. Urol. 2021; 74 (1): 112-122). ARCH ESP UROL 2021; 74:725-726. [PMID: 34605410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article already published, it has been detected that in the summary, on page 112 where it says "water" itshould say "fluid". The corrected text is as follows:Nutrition is tightly associated with the risk of stone events. Apart from genetic predisposition, a correct and balanced diet might prevent incident kidney stones. Several studies analyzed each dietary component and different diets to better understand their impact on stone recurrence. Fluids: High fluids intake is the most important factor for preventing kidney stones disease and for every 200 mL of fluid, the risk of stones is reduced by 13%. Soft drinks seems to be associated to a greater risk of stone events, whereas caffeine and citrus fruits juice are not.Calcium: Normally calcium intake with diet does not exceed 1.2 g/day. A balanced consumption of dairy products is capable of reducing oxalate intestinal absorption and urinary excretion compared to low calcium diet, being protective for stone disease. Oxalate: The exact amount of oxalate contained in different foods is difficult to estimate for its variability, even in the same aliment. In addition, the amount of oxalate consumed was shown to be only a minor risk factor for stone disease, whereas its intestinal absorption is strongly influenced by external factors, such as calcium intake. Dietary oxalate restriction is advisable only in patients with known elevated consumption. Sodium: High sodium intake is both associated with hypertension, heart disease and stone risk. Increased sodium consumption is directly associated to hypercalciuria in both calcium stone formers and healthy subjects. Although dietary sodium restriction to recommended values is always desirable in stone formers, it is difficult to achieve for its broad use in food preparation. Proteins: Animal proteins are associated to increased risk for stone formation, whereas vegetable and dairy proteins are not. Increased meat intake was associated to acidic urine pH, negative calcium balance and reduced anti-lithogenic urinary solutes excretion. Fruits and vegetables: Alkalizing foods are one of the most important factors for stone protection. Their consumption increases anti-lithogenic solutes as citrate, potassium and magnesium. A diet rich in fruits and vegetables is strongly recommended for stone formers. Uric acid: Elevated meat consumption is either associated to increased purine metabolism and acid load, favoring uric acid nephrolithiasis by reducing urine pH and increasing urinary excretion of uric acid, especially in patients affected by metabolic syndrome and diabetes.In conclusion, the most effective diet for stone protection is rich in fruits and vegetables, low in animal proteins and salt, with balanced dairy product consumption and obviously, with elevated fluid intake. These characteristics make vegetarian and Mediterranean diets protective and useful for stone formers, whereas western diet is at risk for stone formation.
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Tang D, Dinh H, Almansour H, Burlutsky G, Bussing J, Eisenhauer B, Gopinath B, Flood VM, Saini B. Evaluation of educational interventions on eye health for dietetic and pharmacy professions: a pre-post study. BMC MEDICAL EDUCATION 2021; 21:478. [PMID: 34493275 PMCID: PMC8424804 DOI: 10.1186/s12909-021-02905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND We piloted an educational intervention that aimed to enhance awareness about nutrition-age-related macular degeneration (AMD) links among practising and student dietitians then expanded the scope of this intervention to include general eye health, which was delivered to pharmacy students. METHODS A pilot intervention was conducted in 2019 at the Dietitians Australia Conference (Gold Coast, Australia) where practising and student dietitians underwent a 2-hour small group educational workshop on nutrition and AMD links. Pre-post questionnaires were administered to participants, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcome was a change in AMD-related nutrition knowledge pre-post intervention. A larger intervention was then conducted at the University of Sydney (Sydney, Australia) where pharmacy students underwent a 4-hour educational module to improve general eye health knowledge, as well as student perceptions and attitudes towards a pharmacists' role in low vision care. Similarly, pre-post questionnaires were administered, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcomes were changes in total knowledge, total perception and total attitude scores pre-post intervention. RESULTS (1) Among 10 accredited and 5 student dietitians, there was significant overall knowledge improvement (mean pre-post score: 7.07 ± 1.94 vs. 10.8 ± 1.01, p = 0.001) specifically around appropriate dietary advice, food sources of key AMD-related nutrients, and awareness of supplements. (2) Among 179 second-year pharmacy students enrolled in the 'Pharmacy Practice' Unit of Study (Bachelor of Pharmacy, University of Sydney), total eye health knowledge (6.25 ± 1.93 vs. 6.64 ± 2.0; p = 0.011) significantly improved, along with total perception scores (41.54 ± 5.26 vs. 42.45 ± 4.95; p = 0.004). Total attitude scores were not significantly different. CONCLUSIONS The pilot intervention improved relevant nutrition-AMD knowledge among practising/student dietitians. The modified intervention for pharmacy students also significantly improved general eye health knowledge as well as students' perception of a pharmacists' role in low vision care.
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Thornton H, Melton T, Johnson C, Belleny Lewis D. Evolving Beyond the World Foods Course: Creating Racially and Ethnically Inclusive Educational Spaces for Dietetics Students. J Acad Nutr Diet 2021; 122:1993-2000. [PMID: 34366238 DOI: 10.1016/j.jand.2021.06.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
Only 13.1% of US registered dietitian nutritionists and 27.8% of students enrolled in US dietetics education programs identify as racially/ethnically diverse individuals. National demographic trends show increasing percentages of racially/ethnically diverse individuals within the broader US and college student populations; however, these changes have not been mirrored within dietetics. Dietetics educators have an ethical and professional mandate to address diversity, equity, and inclusion within their programs. This paper reviews key terminology related to diversity, equity, and inclusion in the context of dietetics education, and describes a new framework to transform dietetics education based on the principles of cultural humility and culturally sustaining teaching. Strategies are presented to facilitate recruitment, admissions, retention, and mentorship for racially/ethnically diverse students and faculty, and to improve diversity, equity, and inclusion within curricula and classrooms. Lastly, this paper provides clear practice applications, including recommendations for program policy change and training/skill building activities for dietetics students, educators, and preceptors.
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Lambert B, Lightfoot K, Meskell R, Whiteley VJ, Martin-McGill KJ, Schoeler NE. Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UK. Nutrients 2021; 13:nu13082484. [PMID: 34444643 PMCID: PMC8400576 DOI: 10.3390/nu13082484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery
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Landry MJ, Bailey DA, Ervin A. You Are Not an Impostor: The Registered Dietitian Nutritionist and Impostor Phenomenon. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:625-630. [PMID: 33775568 DOI: 10.1016/j.jneb.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Impostor phenomenon (IP) interferes with the desire for taking advantage of career opportunities and pursuing career advancement. There is robust literature describing the effects of IP in other health care professions, yet an absence of research exists on IP within the nutrition and dietetics profession. This perspective will explore why nutrition and dietetics professionals may experience IP, specify what might be done to mitigate the negative effects of IP, and describe future research directions. Impostorism is an understudied phenomenon that could have significant implications for the profession of nutrition and dietetics on an individual and systemic level.
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Lee R, Crowley ET, Baines SK, Heaney S, Brown LJ. Patient Perspectives of Living with Coeliac Disease and Accessing Dietetic Services in Rural Australia: A Qualitative Study. Nutrients 2021; 13:nu13062074. [PMID: 34204442 PMCID: PMC8234981 DOI: 10.3390/nu13062074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023] Open
Abstract
Adapting to living with coeliac disease requires individuals to learn about and follow a strict gluten-free diet. Utilising a qualitative inductive approach, this study aimed to explore the perspectives of adults diagnosed with coeliac disease who have accessed dietetic services in a rural outpatient setting. A purposive sample of adults with coeliac disease who had accessed dietetic services from two rural dietetic outpatient clinics were recruited. Semi-structured interviews were conducted by telephone. Data were thematically analysed. Six participants were recruited and interviewed. Three key themes emerged: (i) optimising individualised support and services, (ii) adapting to a gluten-free diet in a rural context, and (iii) managing a gluten-free diet within the context of interpersonal relationships. Key issues identified in the rural context were access to specialist services and the increased cost of gluten-free food in more remote areas. The findings of this study have highlighted the difficulties associated with coeliac disease management and how dietetic consultation has the potential to influence confidence in management and improve lifestyle outcomes. Further qualitative research is required to expand on the findings of this study and inform future dietetic practice that meets the expectations and individual needs of people with coeliac disease in rural settings.
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Huebner GE, McGuirt JT, Perrin MT, Haldeman LA, Allen L. Nondiet Weight-Neutral Curricula Limited in Current Accredited US Dietetic Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:517-523. [PMID: 33541767 DOI: 10.1016/j.jneb.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Determine awareness and prevalence of, and interest in nondiet weight-neutral (NDWN) focused curriculum and factors associated with the presence in accredited dietetic programs throughout the US. METHODS Online cross-sectional survey sent to directors of US Coordinated Programs (n = 60) and Didactic Programs in Dietetics (n = 214). RESULTS 116 programs (42%) responded, 95% reported knowledge of NDWN approaches to weight management like Health at Every Size. Most schools (72%) included NDWN in their curriculum, mostly in a single lecture (53%). Most respondents (74%) reported interest in an NDWN curriculum. Common factors for not including NDWN were: lack of trained and knowledgeable staff (35%) and insufficient space in the curriculum to incorporate additional topics (35%). CONCLUSIONS AND IMPLICATIONS Most knew of NDWN approaches and included in curricula but only as 1 lecture. Faculty training and curriculum flexibility may help support the increased incorporation of NDWN approaches.
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Huntriss R, Haines M, Jones L, Mulligan D. A service evaluation exploring the effectiveness of a locally commissioned tier 3 weight management programme offering face-to-face, telephone and digital dietetic support. Clin Obes 2021; 11:e12444. [PMID: 33600056 DOI: 10.1111/cob.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/28/2022]
Abstract
Obesity continues to be a global health problem with significant costs associated with management, treatment, and obesity-related comorbidities. Tier 3 weight management programmes support patients with complex obesity and traditionally offer interventions through face-to-face delivery. In this study, a service evaluation compared weight loss for adults with a BMI ≥ 45 kg/m2 or ≥ 40 kg/m2 with a comorbidity, who were offered a non-randomized dietetic intervention through face-to-face, telephone, or digital support using the Oviva smartphone app as part of a tier 3 weight management programme. One hundred and sixty-nine patients commenced the core programme. There were no significant differences in weight loss between patients receiving face-to-face (5.3 ± 5.5 kg [-4.1%]), telephone (-4 ± 5.3 kg [-3.4%]) and digital support (-6.1 ± 4.9 kg [-4.5%]) (P = .061), with data reported as intention-to-treat using baseline observation carried forward imputation. Completer data were also analysed at an optional 12-week follow-up where weight loss was maintained with no significant differences between face-to-face (-7.6 ± 9.3 kg [-5.6%]) and digital support (-9.2 ± 7.6) kg [-6.8%]) (P = .135). Furthermore, there were no significant differences in the acceptability of the interventions (P = .261). Due to the potential scalability, resource, and cost-savings of digital care, and improvement in accessibility for some people, digital delivery of weight management programmes should be considered as a care option in weight management services.
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Hutchins AM, Winham DM, Fellows JP, Heer MM. Training interns in nutrition and dietetics: a cross-sectional study of the barriers and motivators to being a Registered Dietitian Nutritionist preceptor. BMC MEDICAL EDUCATION 2021; 21:277. [PMID: 33992103 PMCID: PMC8126131 DOI: 10.1186/s12909-021-02700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND As is common across the health professions, training of Registered Dietitian Nutritionists (RDNs) requires experiential learning for interns/students to gain skills and demonstrate entry-level competency. Preceptors are essential to the experiential learning component of health care professional training, providing supervision and mentoring as students and interns gain the skills required for entry-level practice competency. Over the past 27 years, 47-73% of applicants to dietetic internships have received a placement. Practitioners willing to volunteer as preceptors are needed to generate more internship or experiential learning opportunities for the profession to continue to meet workforce demands. METHODS The objective of this national-level online cross-sectional survey was to identify perceptions and attitudes associated with the preceptor role and incentives that might encourage precepting by current RDNs. A random sample of RDN and Nutrition and Dietetic Technicians, Registered (NDTR) professionals from the Commission on Dietetic Registration credentialed practitioner database were eligible to participate in the online survey. The main outcome measures included perceptions, attitudes, and preferred incentives to precept compared by preceptor experience categories (current, former, never precepted). Comparisons of perceptions, attitudes, and preferred incentives were made between preceptor experience categories using Chi-square and ANOVA. RESULTS Of 2464 invitations, 308 participants had complete variables for analysis. Top incentives were the opportunity to earn continuing education units (65.9%) and having expenses paid to attend a national conference (49.5%). Significantly more (P < 0.001) "former" and "never" preceptors reported the ability to choose when to take an intern, training on how to teach and communicate with interns, and access to an "on-call" specialist as incentives compared to "current" preceptors. Significantly more (P < 0.01) "never" preceptors reported training on internship expectations and the ability to provide input on intern selection process as incentives compared to "current" or "former" preceptors. CONCLUSIONS Incentives to serve as a preceptor differ based on "current", "former", or "never" precepted status. Promoting and strategizing solutions to the current imbalance between the greater number of dietetic internship applicants compared to preceptors should be targeted based on preceptor status to retain current preceptors, encourage former preceptors to return and recruit professionals who have never served.
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YAĞMA NM, ÜNAL E, GÖKLER ME, MOLLAHALİLOĞLU S. Cross-cultural adaptation, reliability, and validity of the Turkish version of the obesity-specific quality of life questionnaire: Quality of Life, Obesity and Dietetics (QOLOD) rating scale. Turk J Med Sci 2021; 51:2369-2376. [PMID: 33964861 PMCID: PMC8742480 DOI: 10.3906/sag-2005-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 05/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background/aim Obesity is one of the main public health issues in many countries including Turkey. The aim of the study is to test cross-cultural adaptation, reliability, and validity of QOLOD rating scale in the Turkish language. Materials and methods This methodological study was conducted among the overweight and obesity people between February-March, 2018 in Ankara Atatürk Training and Research Hospital. The data was collected through self-report and face to face interviews. The QOLOD rating scale has 36 items, a 5-point Likert scale (1–5) is used for each question. Results In the study, of the 180 participants, 101 (56.1%) were female, 79 (43.9%) were male, and the mean age was 43.36 ± 14.28 (min-max 18–87) years. According to the CFA, the Turkish version of QOLOD rating scale shows a multidimensional structure consisting of 34 items. Two items (item 11 and item 35) were excluded from the scale according to the CFA. Cronbach’s Alpha value changes between 0.927–0.930. Conclusion Finding shows that the Turkish version of QOLOD rating scale had sufficient validity and reliability for Turkish population, had strong psychometric characteristics.
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Kistler BM, Moore LW, Benner D, Biruete A, Boaz M, Brunori G, Chen J, Drechsler C, Guebre-Egziabher F, Hensley MK, Iseki K, Kovesdy CP, Kuhlmann MK, Saxena A, Wee PT, Brown-Tortorici A, Garibotto G, Price SR, Yee-Moon Wang A, Kalantar-Zadeh K. The International Society of Renal Nutrition and Metabolism Commentary on the National Kidney Foundation and Academy of Nutrition and Dietetics KDOQI Clinical Practice Guideline for Nutrition in Chronic Kidney Disease. J Ren Nutr 2021; 31:116-120.e1. [PMID: 32737016 PMCID: PMC8045140 DOI: 10.1053/j.jrn.2020.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
The Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to provide an update to the Clinical Practice Guidelines (CPG) for nutrition in chronic kidney disease (CKD). These guidelines provide a valuable update to many aspects of the nutrition care process. They include changes in the recommendations for nutrition screening and assessment, macronutrients, and targets for electrolytes and minerals. The International Society of Renal Nutrition and Metabolism assembled a special review panel of experts and evaluated these recommendations prior to public review. As one of the highlights of the CPG, the recommended dietary protein intake range for patients with diabetic kidney disease is 0.6-0.8 g/kg/day, whereas for CKD patients without diabetes it is 0.55-0.6 g/kg/day. The International Society of Renal Nutrition and Metabolism endorses the CPG with the suggestion that clinicians may consider a more streamlined target of 0.6-0.8 g/kg/day, regardless of CKD etiology, while striving to achieve intakes closer to 0.6 g/kg/day. For implementation of these guidelines, it will be important that all stakeholders work to detect kidney disease early to ensure effective primary and secondary prevention. Once identified, patients should be referred to registered dietitians or the region-specific equivalent, for individualized medical nutrition therapy to slow the progression of CKD. As we turn our attention to the new CPG, we as the renal nutrition community should come together to strengthen the evidence base by standardizing outcomes, increasing collaboration, and funding well-designed observational studies and randomized controlled trials with nutritional and dietary interventions in patients with CKD.
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Tomesko J, Ziegler J, Radler DR, Decker RT. Integration of Objective Structured Clinical Examinations Into Graduate Nutrition and Dietetics Curricula. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:270-273. [PMID: 33487566 DOI: 10.1016/j.jneb.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
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Pace RC, Kirk J. Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition. J Ren Nutr 2021; 31:100-115.e41. [PMID: 33642189 DOI: 10.1053/j.jrn.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nephrology nutrition encompasses therapeutic and preventive nutrition care for individuals through the life cycle and addresses a variety of kidney disorders. Most nephrology nutrition practice focuses on care of individuals with chronic kidney disease, those on dialysis, and recipients of kidney transplants. The Renal Dietitians Dietetic Practice Group, National Kidney Foundation Council on Renal Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nephrology nutrition. The SOP and SOPP for RDNs in Nephrology Nutrition provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the following six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nephrology nutrition and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
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MacQuillan EL, Ford J, Baird K. Clinical Competence Assessed Using Simulation: Development of a Standardized Tool to Assess Nutrition-Focused Physical Exam Skill Competence for Registered Dietitian Nutritionists. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:174-182. [PMID: 33309500 DOI: 10.1016/j.jneb.2020.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study details development and testing of a tool designed to evaluate clinical competence by registered dietitian nutritionists (RDNs) on the nutrition-focused physical exam (NFPE). The process demonstrated in this study can be adapted for assessment of other clinical skills in competency-based education programs, such as Accreditation Council on Education in Nutrition and Dietetics' Future Model of Dietetics Education. DESIGN AND SETTING The tool was tested for content validity, then used to assess the videotaped performance of the NFPE with standardized patients in a simulated clinical environment. PARTICIPANTS Seven expert raters assessed the relevance of the tool's items for content validity. For other tests, the tool was used by 3 dietetics faculty to score a group of 18 RDNs. VARIABLES AND ANALYSIS Content validity was tested using the item-level Content Validity Index. Interrater reliability and internal consistency of the tool were calculated and assessed. RESULTS The interrater reliability results indicated excellent agreement between raters, both overall (kappa statistic = 0.86; 95% confidence interval, 0.86-0.87; P < 0.001) and on individual items. Cronbach α statistic was calculated at α = .91, indicating excellent internal consistency. CONCLUSIONS The tool represents an instrument that can assess competence in the NFPE among RDNs and may be used as a template for development of other competency-based education assessment tools.
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McMaster CM, Wade T, Franklin J, Hart S. A review of treatment manuals for adults with an eating disorder: nutrition content and consistency with current dietetic evidence. Eat Weight Disord 2021; 26:47-60. [PMID: 32002827 DOI: 10.1007/s40519-020-00850-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/14/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aimed to summarise the nutrition and food-related content of treatment manuals for adults with eating disorders (EDs) and assess the degree to which this information conforms with current guidelines and literature. METHODS Treatment manuals for adults with an ED were identified by conducting an online search of Internet book dealer Amazon and University of Sydney library catalogue as per methods used in previous reviews of self-help patient resources. The nutrition and food-related content of these manuals was extracted and reviewed independently by two reviewers using a criteria based on current best evidence to date regarding dietetic treatment for EDs. RESULTS Twenty-two manuals met inclusion criteria, 20 (91%) of which contained some degree of nutrition and food-related content. Two manuals (9%) included content written by a dietitian, six (27%) included citation of dietetic literature to support the recommendations made and eight (36%) recommended a dietitian be consulted as part of a multidisciplinary approach to treatment. Thirteen manuals (60%) contained nutrition and food-related information not substantiated by current evidence. CONCLUSION It is common for treatment manuals for EDs to contain nutrition and food-related content. However, most of the authors of the 22 manuals identified did not appear to collaborate with a dietitian in writing this content or cite peer-reviewed literature to substantiate dietary advice given. Consistent with current clinical practice guidelines, greater collaboration between dietitians and clinicians is required to develop, evaluate and disseminate evidence-based approaches to dietetic management. LEVEL OF EVIDENCE Level V, narrative review.
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Spiker ML, Knoblock-Hahn A, Brown K, Giddens J, Hege AS, Sauer K, Enos DM, Steiber A. Cultivating Sustainable, Resilient, and Healthy Food and Water Systems: A Nutrition-Focused Framework for Action. J Acad Nutr Diet 2021; 120:1057-1067. [PMID: 32446564 DOI: 10.1016/j.jand.2020.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/22/2022]
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Hewko S, Oyesegun A, Clow S, VanLeeuwen C. High turnover in clinical dietetics: a qualitative analysis. BMC Health Serv Res 2021; 21:25. [PMID: 33407423 PMCID: PMC7789381 DOI: 10.1186/s12913-020-06008-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. METHODS Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. RESULTS Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. CONCLUSIONS Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.
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Ferraro PM, Bargagli M. Dietetic and lifestyle recommendations for stone formers. ARCH ESP UROL 2021; 74:112-122. [PMID: 33459627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nutrition is tightly associated with the risk of stone events. A part from genetic predisposition, a correct and balanced diet might prevent incident kidney stones. Several studies analyzed each dietary component and different diets to better understand their impact on stone recurrence. Fluids: High fluids intake is the most important factor for preventing kidney stones disease and for every 200 mL of water, the risk of stones is reduced by 13%. Soft drinks seems to be associated to a greater risk of stone events, whereas caffeine and citrus fruits juice are not. Calcium: Normally calcium intake with diet does not exceed 1.2 g/day. A balanced consumption of dairy products is capable of reducing oxalate intestinal absorption and urinary excretion compared to low calcium diet, being protective for stone disease. Oxalate: The exact amount of oxalate contained in different foods is difficult to estimate for its variability, even in the same aliment. In addition, the amount of oxalate consumed was shown to be only a minor risk factor for stone disease, whereas its intestinal absorption is strongly influenced by external factors, such as calcium intake. Dietary oxalate restriction is advisable only in patients with known elevated consumption. Sodium: High sodium intake is both associated with hypertension, heart disease and stone risk. Increased sodium consumption is directly associated to hypercalciuria in both calcium stone formers and healthy subjects. Although dietary sodium restriction to recommended values is always desirable in stone formers, it is difficult to achieve for its broad use in food preparation. Proteins: Animal proteins are associated to increased risk for stone formation, whereas vegetable and dairy proteins are not. Increased meat intake was associated to acidic urine pH, negative calcium balance and reduced anti-lithogenic urinary solutes excretion.Fruits and vegetables: Alkalizing foods are one of the most important factors for stone protection. Their consumption increases anti-lithogenic solutes as citrate, potassium and magnesium. A diet rich in fruits and vegetables is strongly recommended for stone formers. Uric acid: Elevated meat consumption is either associated to increased purine metabolism and acid load, favoring uric acid nephrolithiasis by reducing urine pH and increasing urinary excretion of uric acid, especially in patients affected by metabolic syndrome and diabetes.In conclusion, the most effective diet for stone protection is rich in fruits and vegetables, low in animal proteins and salt, with balanced dairy product consumption and obviously, with elevated fluid intake. These characteristics make vegetarian and Mediterranean diets protective and useful for stone formers, whereas western diet is at risk for stone formation.
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Newell AM, Troxel W. Influence of Research Involvement on the Interpretation and Implementation of a Research Competency in Dietetic Internship Programs. JOURNAL OF ALLIED HEALTH 2021; 50:47-53. [PMID: 33646249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Experiential learning theory was utilized as the overarching framework for this study because the research experiences of dietetic internship (DI) directors likely influences the way they manage the DI research curriculum. The literature suggests that dietitians and dietetic educators lack research knowledge and skills, resulting in a research-competency gap. The purpose of this study was to examine the relationship of the research involvement of DI directors and their interpretation and implementation of a research competency within their programs. METHODS This study utilized a cross-sectional, survey design, which consisted of DI directors who managed ACEND accredited DI programs (n=96). RESULTS The data indicated that the research involvement of DI directors influences both their interpretation and implementation of the research competency. Discriminant analysis revealed that level of research involvement differentiated significantly among interpretation and implementation of the research competency. CONCLUSIONS The results of this study showed DI directors who scored higher on the research involvement continuum had a more complete interpretation and implementation of the research competency, which reinforces the importance of experiential learning. These findings could be used by DI directors and other dietetic educators to inform curricular decisions that bridge the research-competency gap between curriculum and practice within dietetics.
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Patten EV, Vaterlaus JM. Prevalence of Depression, Anxiety, and Stress in Undergraduate Dietetics Students. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:67-74. [PMID: 33250360 DOI: 10.1016/j.jneb.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand the mental health and stressors of current nutrition and dietetics students. DESIGN Cross-sectional survey. PARTICIPANTS A total of 611 current Didactic Program in Dietetics (DPD) students in the US were recruited through DPD program directors. METHODS Electronic survey included measures of anxiety, stress, depression, and specific stressors. Data analysis included descriptive statistics, chi-square analysis, and qualitative thematic analysis. RESULTS Most students experienced normal levels of depression, anxiety, and stress compared with the general population. A subset experienced some level of depression (30%), anxiety (40%), and stress (27%). Significant sources of stress were postgraduation plans (including internships), managing time, dietetics courses, finances, and self-imposed expectations. CONCLUSIONS AND IMPLICATIONS The identification of a subset of DPD students experiencing symptoms of mental health challenges and recognition that there are common stressors among DPD students may increase awareness among educators, guide development of course policies, and highlight the importance of mitigating major sources of stress for students.
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Farr LT. Self-Promotion, Branding, and Attracting Buyers: I am convinced that you have the power to persuade and influence those who choose your services, how you will provide those services and how much you will be compensated for those services. J Acad Nutr Diet 2020; 120:1789-1790. [PMID: 33099401 DOI: 10.1016/j.jand.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
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