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Journal of Paediatrics and Child Health Mar 2021In newly diagnosed paediatric Crohn disease, exclusive enteral nutrition (EEN) is recommended as a first-line treatment for remission induction. However, EEN protocols...
AIM
In newly diagnosed paediatric Crohn disease, exclusive enteral nutrition (EEN) is recommended as a first-line treatment for remission induction. However, EEN protocols vary internationally. The development of best practice protocols may make it easier to make definitive conclusions about optimal EEN therapy, and may improve patient outcomes. This study aims to determine the variations in current dietitian EEN practice within Australia and New Zealand (NZ) to inform a common EEN protocol in the future, and to gather perspectives on the need for nutrition resources for patients with inflammatory bowel disease (IBD).
METHODS
A questionnaire was created and emailed to paediatric dietitians working with gastroenterologists in public and private paediatric centres in Australia and NZ. Respondents were invited to provide details of their perspectives of EEN therapy and protocol details.
RESULTS
Eighteen paediatric dietitians responded to the questionnaire, 10 from Australia and 8 from NZ. There was clear consensus between respondents on the duration of EEN being 6 and 8 weeks, the need for close dietitian supervision while on EEN, and the method of food reintroduction. There was lack of consensus between dietitians regarding permitted concomitant foods whilst on EEN. This study also determined a potential benchmarking relationship between IBD dietitian hours and numbers of patients on EEN per year in a centre.
CONCLUSIONS
Paediatric dietitians in Australia and NZ are mostly aligned in their practice of EEN. Development of a standard EEN protocol, and patient IBD resources, will further align practice and allow for greater research possibilities.
Topics: Adolescent; Australia; Child; Crohn Disease; Enteral Nutrition; Humans; New Zealand; Nutritionists
PubMed: 33015922
DOI: 10.1111/jpc.15220 -
Nutrition & Dietetics: the Journal of... Sep 2020It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via...
It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth-delivered dietetic consultations are comparable to those delivered in-person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth-delivered dietetic consultations as a responsive and cost-effective alternative or complement to traditional in-person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet-related health and well-being, regardless of their location, income or literacy level, thereby addressing current inequities.
Topics: Australia; Dietary Services; Dietetics; Humans; Nutritionists; Telemedicine
PubMed: 32596950
DOI: 10.1111/1747-0080.12619 -
Nutrients Apr 2021Chronic diarrhoea affects up to 14% of adults, it impacts on quality of life and its cause can be variable. Patients with chronic diarrhoea are presented with a plethora... (Review)
Review
Chronic diarrhoea affects up to 14% of adults, it impacts on quality of life and its cause can be variable. Patients with chronic diarrhoea are presented with a plethora of dietary recommendations, often sought from the internet or provided by those who are untrained or inexperienced. In this review, we summarise the possible causes of chronic diarrhoea that can be managed by diet, the symptom improvement and quality of life benefits but also the potential risks of such dietary treatments. Clinicians need to consider both the benefits and risks of dietary treatments before making dietary recommendations to manage chronic diarrhoea. The pivotal role that dietitians have in ensuring optimal symptom improvement without jeopardising nutritional and overall health is discussed.
Topics: Chronic Disease; Diarrhea; Diet; Humans; Nutritionists; Patient Acceptance of Health Care
PubMed: 33919083
DOI: 10.3390/nu13051393 -
Nutrition in Clinical Practice :... Feb 2022Home enteral nutrition (HEN) is the provision of nutrition through a tube outside the hospital. The Canadian prevalence of HEN is not previously well understood. This...
BACKGROUND
Home enteral nutrition (HEN) is the provision of nutrition through a tube outside the hospital. The Canadian prevalence of HEN is not previously well understood. This study aimed to (1) describe the demographics and healthcare usage of HEN in adults in a Canadian health authority, (2) compare the proportion of HEN-related hospital visits between patients who did and did not receive a community registered dietitian (RD) follow-up, and (3) determine associations between demographic and healthcare usage of HEN adults .
METHODS
A retrospective chart review was conducted on the records of HEN patients with a tube placed between April 1, 2012, and March 31, 2015. Descriptive and comparative statistics were applied.
RESULTS
A total of 390 adults were discharged receiving HEN. The majority (74.9%, n = 271) of the sample did not have any record of visiting a community RD up to 6 years after tube placement. Fifty-three percent of the sample visited the hospital for HEN-related complications, costing CAD $14,324,465.00 (USD $10,677,946.00) to the healthcare system. Multiple regression analysis revealed that females ( P < .05), jejunostomy tubes ( P < .05), and older age ( P < .05) were associated with more hospital or emergency room visits.
CONCLUSION
This study found a higher prevalence of HEN patients and more varied demographic and clinical characteristics than previously reported. The healthcare costs per patient per year exceed previous reports. Further research is needed to explore the population's experiences and develop interventions that improve gaps in the healthcare system.
Topics: Aged; Canada; Enteral Nutrition; Female; Home Care Services; Humans; Intubation, Gastrointestinal; Nutritionists; Retrospective Studies
PubMed: 33754366
DOI: 10.1002/ncp.10649 -
Alimentary Pharmacology & Therapeutics Apr 2023
Topics: Humans; Nutritionists; Surveys and Questionnaires; Health Knowledge, Attitudes, Practice
PubMed: 36952272
DOI: 10.1111/apt.17446 -
Nutrition in Clinical Practice :... Jun 2021Malnutrition is common among patients with gastrointestinal (GI) cancer and contributes to their morbidity and mortality. Nutrition interventions provided by a... (Review)
Review
BACKGROUND
Malnutrition is common among patients with gastrointestinal (GI) cancer and contributes to their morbidity and mortality. Nutrition interventions provided by a registered dietitian (RD) or dietitian may improve nutrition status and patient outcomes; however, there are few studies that attempt to define the contribution of the dietitian to these outcomes.
OBJECTIVE
Our objective was to identify the value added by the dietitian to the care of patients with GI malignancies.
METHODS
A structured review was conducted using PubMed, CINAHL, Scopus, Medline, and ClinicalKey (all dates up to December 2019). Patients included those with GI malignancies undergoing cancer treatment and receiving intervention provided by an dietitian. Intervention included provision of medical nutrition therapy by an dietitian in the form of counseling, diet advice, oral nutritional supplementation, and enteral and/or parenteral nutrition-directed recommendations.
RESULTS
Ten relevant studies were identified and included for analysis. Studies suggest that nutrition counseling by a dietitian during cancer treatment results in improved weight maintenance and energy intake. Preoperative nutrition counseling and inpatient dietitian intervention seem to decrease length of stay after major surgery.
CONCLUSIONS
We conclude that the dietitian, especially when providing nutrition counseling, improves the nutrition-related outcomes of patients with GI malignancies. The small number of existent studies highlights the need for further research to define the impact of dietitian interventions and to determine which particular interventions best improve patient outcomes.
Topics: Gastrointestinal Neoplasms; Humans; Malnutrition; Nutritional Status; Nutritionists; Parenteral Nutrition
PubMed: 32822097
DOI: 10.1002/ncp.10568 -
Clinical Nutrition ESPEN Feb 2022Explore the benefits and feasibility of a dual training program for dietetics and nursing to increase nutrition in clinical practice. (Review)
Review
PURPOSE
Explore the benefits and feasibility of a dual training program for dietetics and nursing to increase nutrition in clinical practice.
METHODS
A professional interest survey on the perceived value of a dual program with 222 registered nurses (RN) and registered dietitian nutritionists (RDN) and an in-depth literature review were completed.
RESULTS
A majority of RNs indicated the addition of the RDN would be beneficial for supporting patients with diet-related chronic diseases and performing nutritional assessments and interventions. The RDN respondents indicated a dual program approach would also improve the ability to serve a small community or place of employment that is limited in having both a full-time RDN and RN, and rated benefits for performing more medical and laboratory procedures. The RDNs also indicated the dual program could help increase their income potential. Both dual Master's and dual Bachelor's programs were rated as valuable. Of the 18 (8%) of respondents who had both RDN and RN credentials, half indicated personal growth and interest was the incentive for pursuing the dual training; whereas half indicated professional incentives (e.g., no RDN in the area, improving specialty care, job security, lack of opportunities), The literature review indicated no studies on the efficacy of a dual RDN-RN program on health outcomes; however, studies have shown that individualized counseling from RDNs is more beneficial than general nutritional counselling from other health care providers not specifically trained in dietary assessments. Noted barriers to pursuing dual training included time and cost, and some respondents in both specialties were not interested in a dual program.
DISCUSSION
These results support providing students with dual program options, although further exploration of the specific approach is warranted, particularly decreasing time-to-degree while not affecting efficacy.
Topics: Dietetics; Humans; Nurses; Nutrition Therapy; Nutritional Status; Nutritionists
PubMed: 35063216
DOI: 10.1016/j.clnesp.2021.11.030 -
Public Health Nutrition Oct 2021The objective of this scoping review was to examine the research question: In the adults with or without cardiometabolic risk, what is the availability of literature... (Review)
Review
OBJECTIVE
The objective of this scoping review was to examine the research question: In the adults with or without cardiometabolic risk, what is the availability of literature examining interventions to improve or maintain nutrition and physical activity-related outcomes? Sub-topics included: (1) behaviour counseling or coaching from a dietitian/nutritionist or exercise practitioner, (2) mobile applications to improve nutrition and physical activity and (3) nutritional ergogenic aids.
DESIGN
The current study is a scoping review. A literature search of the Medline Complete, CINAHL Complete, Cochrane Database of Systematic Reviews and other databases was conducted to identify articles published in the English language from January 2005 until May 2020. Data were synthesised using bubble charts and heat maps.
SETTING
Out-patient, community and workplace.
PARTICIPANTS
Adults with or without cardiometabolic risk factors living in economically developed countries.
RESULTS
Searches resulted in 19 474 unique articles and 170 articles were included in this scoping review, including one guideline, thirty systematic reviews (SR), 134 randomised controlled trials and five non-randomised trials. Mobile applications (n 37) as well as ergogenic aids (n 87) have been addressed in several recent studies, including SR. While primary research has examined the effect of individual-level nutrition and physical activity counseling or coaching from a dietitian/nutritionist and/or exercise practitioner (n 48), interventions provided by these practitioners have not been recently synthesised in SR.
CONCLUSION
SR of behaviour counseling or coaching provided by a dietitian/nutritionist and/or exercise practitioner are needed and can inform practice for practitioners working with individuals who are healthy or have cardiometabolic risk.
Topics: Adult; Cardiovascular Diseases; Exercise; Humans; Nutritional Status; Nutritionists; Systematic Reviews as Topic
PubMed: 34030758
DOI: 10.1017/S1368980021002184 -
Journal of Renal Nutrition : the... Jan 2022This study described the job responsibilities and modalities of care among dialysis dietitians in the United States and their observations regarding the nutrition needs...
OBJECTIVE
This study described the job responsibilities and modalities of care among dialysis dietitians in the United States and their observations regarding the nutrition needs of their patients, during the COVID-19 pandemic.
DESIGN AND METHODS
Cross-sectional online survey captures dietitian characteristics and responsibilities, dialysis facility characteristics, and patient needs. We recruited US dialysis dietitians. We used chi-square tests to compare respondent stress and facility-level policies regarding eating/drinking and oral nutrition supplements based on facility ownership type.
RESULTS
We received 191 complete or partial survey responses. Sixty-three percent of respondents stated that their center banned eating/drinking during dialysis due to COVID-19 masking policies. DaVita and non-profit facilities were significantly more likely to still allow eating/drinking during dialysis (31% and 29%, respectively) compared to Fresenius facilities (7%). A common theme in open-ended responses regarding nutrition care for COVID-19-positive patients was providing less care to these patients. A majority of respondents admitted to stress from working in healthcare during COVID-19. The majority of respondents indicated that patients were taking precautions such as having a family member or friend grocery shop for them (69%) or going to the store less often (60%). Just over a quarter of respondents indicated that affordability of food was a concern among patients. Seventy-two percent reported that patients were cooking at home more often, 60% had observed an increase in serum phosphorus, and 72% an increase in interdialytic weight gain.
CONCLUSIONS
Due to the increased risk of malnutrition and symptoms that can affect dietary intake in COVID-positive patients, and the economic conditions leading to increased rates of food insecurity, dietitians must be proactive in preventing and/or treating malnutrition through adequate protein and energy intake. Eating/drinking bans should not become permanent and dialysis centers should take precautions to allow intradialytic meals and oral nutrition supplement protocols to continue during the pandemic.
Topics: COVID-19; Cross-Sectional Studies; Humans; Nutritionists; Pandemics; Renal Dialysis; SARS-CoV-2; United States
PubMed: 34465503
DOI: 10.1053/j.jrn.2021.07.006 -
Journal of Renal Nutrition : the... Nov 2023People living with chronic kidney disease (CKD) require long-term support at varying levels of individualization, intensity, and frequency. Mobile and digital models of... (Review)
Review
People living with chronic kidney disease (CKD) require long-term support at varying levels of individualization, intensity, and frequency. Mobile and digital models of nutrition care can facilitate long-term behavior change, address nutrition issues proactively, reduce travel burden, and reach people without access to health care more easily. However, while traditional health delivery continues to be digitally disrupted, there are many barriers to address before mobile and digitally supported models of nutrition care can become business as usual in nephrology and nutrition care practice. This paper overviews the current evidence base concerning the past and present mobile and digital health programs to improve nutrition in CKD and highlights the novel future trends in this field. The way nutrition and dietetic care can be feasible, safe, and potentially effective when delivered using various digital and virtual technologies, including consultations, assessments, establishment of diagnoses, formulation of plans, and monitoring/reviewing clinical progress is discussed. Of the available evidence to date, these modalities appear to improve dietary sodium intake and diet quality, self-efficacy, interdialytic weight gain, and body weight. Many barriers exist to sustaining the continued and widespread adoption of digital and mobile health-supported nutrition care in CKD. These include patient-, clinician-, and health system-specific and are discussed in detail. Mobile and digital-supported models of nutrition care present an exciting opportunity to assist kidney dietitians deliver patient-centred nutrition care in CKD.
Topics: Humans; Nutritional Status; Diet; Renal Insufficiency, Chronic; Dietetics; Nutritionists
PubMed: 36965753
DOI: 10.1053/j.jrn.2023.02.004