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Canadian Journal of Dietetic Practice... Sep 2017
Topics: Canada; Dietetics; Food; Health Promotion; Humans; Nutritionists
PubMed: 28799797
DOI: 10.3148/cjdpr-2017-025 -
Nutrients Sep 2020Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral...
Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.
Topics: Aged; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nutritionists; Referral and Consultation
PubMed: 32962105
DOI: 10.3390/nu12092863 -
Nutrition & Dietetics: the Journal of... Jul 2022Scientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to... (Review)
Review
AIM
Scientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to provide a comprehensive overview of the topic of the therapeutic relationship between clients and dietitians in the individual counselling context by summarising empirical literature into qualitative themes.
METHODS
An electronic literature search of the Cumulative Index of Nursing and Allied Health Literature, PsychInfo, Scopus and Web of Science databases was conducted in October 2018 and repeated in February 2021. Studies were included if they explicitly referred to the therapeutic relationship (or associated terms), were based on study data and available in full text. Extracted data were checked by a second researcher and the methodological quality was evaluated independently by two researchers using the Mixed Methods Appraisal Tool. An iterative process of qualitatively coding, categorising and comparing data to examine recurring themes was applied.
RESULTS
Seventy-six studies met the inclusion criteria. Five themes were identified which showed the extent and nature of research in this area. Studies revealed the therapeutic relationship: (i) is valued within clinical dietetic practice, (ii) involves complex and multifactorial interactions, (iii) is perceived as having a positive influence, (iv) requires skills training and (v) is embedded in practice models and tools.
CONCLUSION
Studies show the therapeutic relationship is a valued and multifactorial component of clinical dietetic practice and is perceived to positively influence the client and dietitian. Observational data are needed to assess the extent to which the strength of the therapeutic relationship might contribute to clients' health outcomes.
Topics: Counseling; Dietetics; Humans; Nutritionists; Referral and Consultation
PubMed: 35324041
DOI: 10.1111/1747-0080.12723 -
Australian Critical Care : Official... May 2024Recommendations to facilitate evidence-based nutrition provision for critically ill children exist and indicate the importance of nutrition in this population. Despite...
BACKGROUND
Recommendations to facilitate evidence-based nutrition provision for critically ill children exist and indicate the importance of nutrition in this population. Despite these recommendations, it is currently unknown how well Australian and New Zealand (ANZ) paediatric intensive care units (PICUs) are equipped to provide nutrition care.
OBJECTIVES
The objectives of this project were to describe the dietitian and nutrition-related practices and resources in ANZ PICUs.
METHODS
A clinician survey was completed as a component of an observational study across nine ANZ PICUs in June 2021. The online survey comprised 31 questions. Data points included reporting on dietetics resourcing, local feeding-related guidelines and algorithms, nutrition screening and assessment practices, anthropometry practices, and indirect calorimetry (IC) device availability and local technical expertise. Data are presented as frequency (%), mean (standard deviation), or median (interquartile range).
RESULTS
Survey responses were received from all nine participating sites. Dietetics staffing per available PICU bed ranged from 0.01 to 0.07 full-time equivalent (median: 0.03 [interquartile range: 0.02-0.04]). Nutrition screening was established in three (33%) units, all of which used the Paediatric Nutrition Screening Tool. Dietitians consulted all appropriate patients (or where capacity allowed) in six (66%) units and on a request or referral basis only in three (33%) units. All units possessed a local feeding guideline or algorithm. An IC device was available in two (22%) PICUs and was used in one of these units.
CONCLUSIONS
This is the first study to describe the dietitian and nutrition-related practices and resources of ANZ PICUs. Areas for potential improvement include dietetics full-time equivalent, routine nutrition assessment, and access to IC.
Topics: Child; Humans; Australia; Intensive Care Units, Pediatric; New Zealand; Nutritional Status; Nutritionists
PubMed: 37169654
DOI: 10.1016/j.aucc.2023.03.003 -
Clinical Nutrition ESPEN Dec 2023Eating disorder diagnoses and disordered eating behaviours are more prevalent in people living with Type 1 Diabetes Mellitus, in particular in adolescents. The role of... (Review)
Review
A scoping review exploring the role of the dietitian in the identification and management of eating disorders and disordered eating in adolescents and adults with type 1 diabetes mellitus.
BACKGROUND
Eating disorder diagnoses and disordered eating behaviours are more prevalent in people living with Type 1 Diabetes Mellitus, in particular in adolescents. The role of the dietitian in this setting is not clearly outlined in the literature.
AIM
This scoping review aims to outline the available information for the role of the dietitian in identifying and managing eating disorders in adolescents and adults with co-occurring Type 1 Diabetes Mellitus (T1DM) in a clinical setting.
METHODS
The Johanna Briggs Institute was utilised to guide this scoping review and to develop a search strategy for relevant databases. Relevant organisations and societies websites and professional magazines were reviewed as part of the grey literature search.
RESULTS
38 peer reviewed journal articles, 5 professional articles, 5 book chapters and 11 clinical guidelines were included in this scoping review. Roles for the dietitian in identification, prevention and screening for eating disorders in Type 1 Diabetes Mellitus were identified and outlined in a visual workflow. The role of the dietitian in the management of eating disorder in both the outpatient/community and inpatient setting and as core member of the multidisciplinary team was detailed in the literature.
CONCLUSION
This scoping review mapped the available information in the current literature on the role of the dietitian in the identification and management of eating disorders and disordered eating in adolescents and adults with a dual diagnosis of T1DM. The reviewed literature suggests there is a strong reliance on expert opinion and practice to inform the role of the dietitian. Further research is required in order to ensure more robust evidence-based practice in this area.
Topics: Adult; Humans; Adolescent; Diabetes Mellitus, Type 1; Nutritionists; Feeding and Eating Disorders; Outpatients
PubMed: 38057030
DOI: 10.1016/j.clnesp.2023.10.038 -
Nutrients Feb 2022Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital...
Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians-an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.
Topics: Dietetics; Humans; Malnutrition; Nutritional Status; Nutritionists; Qualitative Research
PubMed: 35268008
DOI: 10.3390/nu14051037 -
Heliyon Aug 2023The dietitian service at a metropolitan health service in Queensland, Australia has a non-engagement rate for high-risk antenatal women of 50%.
PROBLEM
The dietitian service at a metropolitan health service in Queensland, Australia has a non-engagement rate for high-risk antenatal women of 50%.
AIM
Determine which attributes are related to non-attendance at dietitian appointments, and women's perceptions and attitudes towards dietitian appointments during pregnancy.
METHODS
An explanatory mixed-methods design was utilised, with first phase including 103 antenatal women referred to a dietitian in 2021 and compared the attributes of those who attended with those who did not engage. Queensland Health electronic databases were used to collect attribute data, which were then analysed with Jamovi (version 1.6) for descriptive, correlational, multivariate analyses of variance MANOVA. Second phase included seven semi-structured interviews with women attending a dietitian appointment, and subsequently analysed through thematic analysis.
RESULTS
Distance from clinic was not related to clinic attendance, and women reported they would attend regardless of distance or work status. Non-attendance was related to higher gravidity, parity, and if referred for obesity, but not previous gastric sleeve or underweight referral. Six themes were identified from the interview data: "Women want to be treated like an individual," "It's all about expectations," "Midwives hold the key," "Preferences in receiving dietary information," "Weight has been a long-term problem and is a sensitive topic," and "Barriers to attendance."
CONCLUSION
Antenatal services can adjust service delivery to improve engagement in weight management services during pregnancy. Telehealth appointments may reduce non-engagement due to distance from clinic. Demystifying the dietitian appointment, ensuring non-judgemental referral processes and collaboration between midwives and dietitians will ensure that women value the service.
PubMed: 37636384
DOI: 10.1016/j.heliyon.2023.e18106 -
BMC Gastroenterology Jul 2023Gastroparesis is delayed gastric emptying in the absence of obstruction; dietary modifications are first-line treatment. However, we do not know the factors related to...
BACKGROUND
Gastroparesis is delayed gastric emptying in the absence of obstruction; dietary modifications are first-line treatment. However, we do not know the factors related to provision of dietary recommendations.
METHODS
We sought to determine how often pediatric patients with gastroparesis receive dietary education (from a gastroenterology provider vs dietitian), the recommendations given, and factors related to these outcomes. We performed a retrospective chart review of children 2- to 18-years-old managed by pediatric gastroenterology providers at our institution. Patient demographics and clinical data, dietary advice given (if any), and dietitian consultation (if any), practice location, and prokinetic use were captured. An adjusted binomial regression model identified factors associated with dietary education provision, dietitian consultation, and diet(s) recommended.
RESULTS
Of 161 patients who met criteria, 98 (60.8%) received dietary education and 42 (26.1%) met with a dietitian. The most common recommendation by gastroenterology providers and dietitians was diet composition adjustment (26.5% and 47.6%, respectively). Patients with nausea/vomiting were less likely to receive dietary education or be recommended to adjust diet composition. Patients with weight loss/failure to thrive were more likely to receive dietitian support. Patients seen in the community vs medical center outpatient setting were more likely to be recommended a low-fat diet.
CONCLUSIONS
Only a little over half of children with gastroparesis receive dietary education and use of a dietitian's expertise is much less frequent. Symptoms and clinical setting appear related to what, where, and by whom guidance is provided.
Topics: Humans; Child; Child, Preschool; Adolescent; Retrospective Studies; Gastroparesis; Diet; Vomiting; Nausea; Gastric Emptying
PubMed: 37460973
DOI: 10.1186/s12876-023-02865-6 -
Telemedicine Reports 2022Hospitals are constantly searching for opportunities to improve efficiency, and telehealth (TH) has recently emerged as a strategy to assist in patient flow. We...
BACKGROUND
Hospitals are constantly searching for opportunities to improve efficiency, and telehealth (TH) has recently emerged as a strategy to assist in patient flow. We evaluated two methods of dietary counseling offered to patients in the time period between the medical and final hospital discharge. Counseling was given either the TH group or the face to face (FTF) group to the patients and their respective impact was evaluated on the patients' satisfaction and on the hospital patient flow.
METHODS
This study was a prospective, randomized clinical trial where patients were randomized to receive dietary counseling TH (use of tablet) or FTF at the time of hospital discharge. We evaluate the duration of time between medical discharge and hospital discharge; between requesting dietary counseling and dietitian's arrival; and duration of dietary counseling. At the end of dietary counseling, both groups received a patient satisfaction questionnaire to answer.
RESULTS
A total of 159 patients were randomized to receive dietary counseling TH (TH, = 78) or FTF (FTF, = 81). The two groups TH and FTF did not differ in terms of the median time between (1) medical and hospital discharge; (2) requesting counseling and the dietitian's arrival; and (3) duration of dietary counseling. Both groups mostly reported being "satisfied" or "above expectations," and the FTF group scored "highest satisfaction" more often relative to the dietitian's work and interaction and on confidence in the dietitian's orientations. Finally, in the TH group, 90.7% graded likely-4 or very likely-5 when asked whether dietary counseling can be conducted entirely TH, and 92% answered "4" or "5" when asked whether they would recommend dietary counseling TH.
CONCLUSIONS
Although the FTF group had a greater overall satisfaction relative to the TH group, TH proved to be a useful tool for dietary counseling.The trial has only Institutional Review Board approval (protocol 2685-16).
PubMed: 35860304
DOI: 10.1089/tmr.2021.0054 -
Canadian Journal of Dietetic Practice... Dec 2019
Topics: Canada; Diet, Healthy; Humans; Nutritionists; Planets
PubMed: 31736395
DOI: 10.3148/cjdpr-2019-028