Practice Dietitians Research Articles

Impact of lifestyle interventions in cardiac rehabilitation for individuals with ischaemic heart disease: a prospective cohort study

Background/Aims Lifestyle interventions are recommended in cardiac rehabilitation guidelines to reduce cardiovascular risk and prevent heart attacks. Therefore, it is important to investigate their effectiveness in primary healthcare settings to improve outcomes in individuals with ischaemic heart disease. The aim of this study was to examine the association between adherence and completion of cardiac rehabilitation and outcomes related to waist circumference and physical performance in primary healthcare settings. Methods A total of 514 individuals diagnosed with ischaemic heart disease were enrolled from ten primary healthcare settings in the Central Denmark Region to participate in cardiac rehabilitation. Participants were categorised based on the completion of a dietary intervention. Changes in waist circumference from baseline to the 12-week follow-up were measured. Adherence to the exercise intervention was assessed based on participation in ≥80% or <80% of training sessions. Changes in physical performance, specifically a 10% improvement in the Watt-max bicycle test, were evaluated over the same period. Linear and logistic regression analyses were conducted, both crude and adjusted for potential confounders. Results Of the 514 participants, 317 (70.8%) who completed the dietary intervention experienced an average reduction of –1.32 cm (95% confidence interval: –1.91 to –0.74 cm) in waist circumference, compared to –0.50 cm for non-completers (P=0.019). Additionally, 276 (56.2%) participants adhered to ≥80% of the exercise intervention, with 237 (66.7%) showing an improvement of ≥10% in Watt-max from baseline to follow-up. Individuals who adhered to ≥80% of the exercise intervention were twice as likely to achieve a ≥10% improvement in Watt-max compared to those with <80% adherence (P=0.334). Conclusions Both dietary and exercise interventions administered in primary healthcare settings were associated with positive changes in waist circumference and physical performance. Implications for practice Dietitians should focus on motivating patients to complete dietary interventions, which can significantly reduce waist circumference. Physiotherapists should emphasise the importance of adherence to exercise programmes. Encouraging patients to meet adherence targets, both in structured rehabilitation and home-based activities, is vital to achieve long-term health benefits.

Management of eating disorders during pregnancy: A survey of Australian dietitians in clinical practice.

Eating disorders (EDs) are estimated to affect 5.2%-7.5% of pregnant women, equating to 15,800-23,000 births in Australia annually. In pregnancy, an ED increases the risk of complications for both mother and child. Heightened motivation and increased utilisation of healthcare services during pregnancy present an opportunity to identify and commence ED treatment. Dietetic management of EDs differs from nutrition guidelines for pregnancy. This study aimed to assess current practice, confidence and training needs of dietitians to manage EDs in pregnancy. A cross-sectional survey of Australian dietitians with past year exposure to ED and/or antenatal fields was completed using Microsoft Forms between November 2022 and January 2023. One hundred and seventeen responses were analysed. Confidence was less for assessment of a woman with an active ED in pregnancy than a pregnant woman with a history of an ED, pregnancy or an ED alone (p < 0.001). Greater than 5 years of experience as a dietitian, but without recent exposure to the patient population, was associated with increased confidence (p < 0.01). Almost half provided descriptions of treatments and interventions used to treat a pregnant woman with an ED, some of which conflict with ED or antenatal guidelines. Dietitians were more likely to weigh a person with an ED in pregnancy. Most respondents indicated further training (93%) and guidelines (98%) would be helpful. This is the first investigation into the dietetic management of EDs in pregnancy, and it highlights a need for guidelines and training for dietitians.

Attitudes and Practices of Dietitians Regarding Gut Microbiota in Health-An Online Survey of the European Federation of the Associations of Dietitians (EFAD).

Explorations of the current attitudes and practices of dietitians regarding the gut microbiota in health are scarce. In this online survey, we assessed the attitudes and practices of dietitians across Europe concerning gut microbiome parameters and the manipulation of the gut microbiota. Pre-graduate dietetic students and other professionals were also invited to participate. The potential interest and preferences of the participants for future educational initiatives about the gut microbiota and the educational resources used were further explored. A total of 179 full responses were recorded (dietitians, n = 155), mainly from the southern and western regions. Most of the participants (>90.0%) believed that probiotics and prebiotics have a place in nutritional practice and that fermented foods with live microbial cultures should be a part of food-based dietary guidelines. A strong belief in the beneficial roles of probiotics and prebiotics in some health situations was also reported among the participants. Most of the dietitians recognised the importance of gut microbiota manipulation and advised the use of probiotics and prebiotics in dietary practice, and they felt quite confident applying the relevant information in their daily practice. Nevertheless, misconceptions were identified, and further guideline-oriented education is necessary. The interest in future e-learning initiatives was high among the participants, and the sources of knowledge, educative formats, and potential areas for further educational efforts were indicated.

Assessing the Level of Knowledge, Implementation Practices, and Use of Digital Applications for the Optimal Adoption of the Nutrition Care Process in Greece.

The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform "SurveyMonkey version 4.1.1". The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation.

Private practice dietetics: A scoping review of the literature.

Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports,statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

Exploring Australian Dietitians' knowledge, experience and perspectives of time-restricted eating in private practice: A qualitative study.

Time-restricted eating is a novel nutrition intervention with evidence of beneficial effects on weight loss, blood glucose management, and other metabolic health outcomes. Adherence to time-restricted eating is higher than some traditional nutrition interventions to support individuals living with overweight/obesity and type 2 diabetes mellitus. However, there may be an evidence-practice gap of time-restricted eating in Australian dietetic practice. The present study aimed to explore dietitians' knowledge, experiences, and perspectives of time-restricted eating and timing of eating advice in practice. Semi-structured interviews with 10 private practice dietitians across Australia were conducted. Audio recordings were transcribed and analysed thematically. Six themes were identified: (i) distinction of time-restricted eating to other fasting protocols; (ii) knowledge of health benefits of time-restricted eating; (iii) patient-led advice frequently given: timing of breakfast and dinner; (iv) dietitian-led advice frequently given: eating cut-off time to avoid late night snacking; (v) barriers and facilitators to offering time-restricted eating or timing of eating advice; (vi) timing of eating advice within professional guidelines and resources. These findings suggest the need for development of professional resources and educational development tools for dietitians on time-restricted eating.

Private practice dietetics workforce: A review of the literature

Private practice is the fastest growing employment sector for dietitians in Australia, including for new graduates(1). There is an anecdotal concern that current graduate cohorts are not adequately prepared for private practice. The present study aims to assess the existing literature relevant to workforce development specific to private practice dietetics, including areas such as workforce size, distribution, competency, practices and global challenges. The secondary aim is to identify gaps in the literature to inform future priority areas and to inform private practice dietetics workforce development research. Five databases were systematically searched from inception to August 2023 and grey-literature was searched using the Google search engine using key search terms to identify studies for inclusion. Of the 2361 peer-reviewed publications and 1800 grey literature, eighty were included. Directed content analysis and qualitative constant comparison technique were used to deductively extract data from eligible private practice literature. Intelligence sources covering the following themes proved to be limited: workforce size, distribution, attributes, demography, supply/preparation, competencies, continued professional development and challenges. However, clear structural issues present workforce challenges for private practice dietitians. There is an overwhelming paucity of comprehensive literature on the private practice dietetics workforce across the world. Private practice dietetics workforce development research is warranted to address current research gaps in a coordinated, collaborative approach to ensure this rapidly expanding workforce is well supported.

Evaluation of the role of an advanced practice dietitian in the intensive care unit

In Swiss intensive care units (ICUs), nutritional management is hardly or not at all supported or supervised by dietitians. Nutritional management in the ICU is mainly performed by ICU nursing staff and intensive care specialists. In 2022, the role of an advanced practice dietitian (APD) was newly defined, created, and implemented in aSwiss ICU as part of apilot project. In contrast to other countries, APDs are still scarce in Switzerland. Evaluation of the APD role is essential to further define the position and adapt it to needs. The aim of this survey was to evaluate the impact of the APD role 8months after implementation. The survey was conducted via online survey in February and March 2023. Atotal of 34members of the ICU team participated, including physicians (n = 11), nurses (n = 20), and speech therapists (n = 3). In addition to workload, years worked in the company, and shiftwork, questions were asked about the level of awareness of the new APD position, integration of the APD into the ICU team, and the impact of the APD on nutritional management and the situation of the participants, as well as regarding documentation and prescribing skills. Adescriptive analysis of the data was carried out in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). The majority are aware of the APD and consider her as part of the ICU team. From the treatment team's point of view, the quality of the nutritional care provided as by the APD has improved and there is added value for patients and the ICU team. The delegated prescribing competence seems to improve nutritional management noticeably and is perceived as helpful and relieving by amajority. How the position will develop in terms of the competence profile remains to be seen.

Attitudes and knowledge of dietitian practice among a representative sample of Israeli adults

BackgroundThere is confusion among members of the general public regarding the role of dietitians in healthcare. Little is known about public attitudes towards dietitians among the general public in Israel. ObjectivesThe present study aims to identify beliefs and attitudes about dietitians in clinical practice held by a representative sample of Israeli adults. MethodsThe present cross-sectional survey was conducted online. ResultsA total of 402 Israeli adults participated. The majority of respondents indicated that dietitians perform nutrition consultations and weight loss counselling. More than half of respondents knew that dietitians have at least a bachelor’s degree, but more than one third thought the degree was in alternative medicine. The majority of respondents ranked dietitians as the healthcare professionals with the greatest knowledge of human nutrition. Approximately have of respondents had been previously treated by a dietitian, and these people were more likely indicate the importance of nutrition care in treating chronic disease; further, they stated that dietitians utilize biochemical, anthropometric and other data in order to personalize nutrition care. In logistic regression analyses of specific dietitian roles, prior treatment by a dietitian emerged as a robust predictor of the role of the dietitian in healthcare. DiscussionRespondents identified dietitians as the professionals with the most knowledge of nutrition and the clinicians with whom they would most likely consult if they desired to change their eating habits.

Supporting Dietitians in Practice: Professional Development Activities of Dietitians of Canada in the Past 30 Years

Dietitians of Canada (DC) was established in 1997 from the Canadian Dietetic Association and the provincial associations. This project is part of a larger program of work to document the recent history of Canadian dietetic practice, including the professional development (PD) initiatives DC has provided since its inception. The aims of the present study are to synthesize a timeline of PD events since 1993, understand the context that led to their development, and understand their impact on the profession. 13 key informants were recruited by email, of which 11 semi-structured interviews were conducted, and 8 participants provided written contributions. Interview transcripts and written contributions were analyzed thematically, and a final timeline of events was developed. Six themes were found: 1) the use of technology in PD tools, e.g. online courses, Learning on Demand; 2) conferences and workshops , e.g. national conference, Coast-to-Coast workshops; 3) initiatives that placed DC as a leader in health and nutrition, e.g. Practice-based Evidence in Nutrition (PEN); 4) informal discussion about emerging issues in dietetics, e.g. PEN Current Issues, Practice Blog; 5) DC actively sought member input to inform PD strategy, e.g. members issues forums; and, 6) DC PD events demonstrated their support for research and dietetic education, e.g. relationship with CFDR, public health online course. Key concerns for the future included: declining DC membership and funding, and dietetics not keeping pace with other professions on PD. The successes and failures of initiatives in this time period can inform the development of DC’s PD strategy for the coming decades.

Oral health knowledge, attitudes and practices of dietitians in Australia: A national survey.

Dietitians are a well-placed profession to be providing pre-emptive oral health promotion. Despite recommendations that oral health promotion should be routinely part of dietetic practice, there is limited data informing the current practices of clinical dietitians in this area across Australia. Hence, the aim of this study was to investigate the knowledge and practices of Australian dietitians and oral health promotion. A cross-sectional survey was undertaken involving registered clinical dietitians in Australia using purposive and snowballing sampling (social media/dietetic organisations/public databases). Data were analysed using descriptive and inferential statistics. A total of 149 dietitians participated in the national survey. Overall, dietitians were knowledgeable about oral health risk factors and preventative measures across general health domains. Majority of dietitians agreed that oral health can affect nutrition interventions (95.5%) and dietitians should be discussing oral health (88.0%). However, nearly half were not confident in providing counselling or education and felt that undergraduate training for oral health promotion was inadequate (78.2%). A small proportion (6.0%) of dietitians were already providing oral health promotion regularly. Key barriers included a lack of clear guidelines for practice, limited training opportunities and indistinct referral pathways. Dietitians have acknowledged that oral health promotion should be incorporated into their practice. However, they are challenged by a lack of resources and training to support this in clinical practice. SO WHAT?: Capacity building dietitians to promote oral health allows opportunity for improvement in the oral health, nutritional status and quality of life of priority population groups.

Collaborative leadership to support sustainability in practice for dietitians as allied health professionals.

Allied health professionals (AHPs) have an important role to support the Greener National Health Service (NHS) agenda. Dietitians are AHPs who are already demonstrating strong influence on food sustainability advocacy. There is call for more collaboration across the health professions to optimise "green" leadership in the pursuit of planetary health. The present study aimed to investigate the perceived role of AHP leaders and future leaders around more sustainable healthcare practices. A mixed methods approach using audio-recorded semi-structured interviews with strategic AHP leaders (n = 11) and focus groups with student AHPs (n = 2). Standardised open-ended questions considered concepts of (i) leadership, (ii) green agenda, (iii) collaboration and (iv) sustainability. Purposive sampling used already established AHP networks. Thematic analysis systematically generated codes and themes with dietetic narratives drawn out specifically as exemplars. The findings represent diverse AHP voices, with six of 14 AHPs analysed, including dietetic (future) leaders. Three key themes emerged: (1) collective vision of sustainable practice; (2) empowering, enabling and embedding; and (3) embracing collaborative change. Dietetic specific narratives included food waste, NHS food supply chain issues, and tensions between health and sustainability advice. The present study shows that collaborative leadership is a core aspiration across AHP leaders and future leaders to inform the green agenda. Despite inherent challenges, participant perceptions illustrate how "change leadership" might be realised to support the net zero agenda within health and social care. Dietitians possess the relevant skills and competencies, and therefore have a fundamental role in evolving collaborative leadership and directing transformational change towards greener healthcare practices. Recommendations are made for future leaders to embrace this agenda to meet the ambitious net zero targets.

Exploring the role of dietitians in mental health services and the perceived barriers and enablers to service delivery: A cross-sectional study.

Mental health is a rapidly evolving area of practice for dietitians. The role of dietitians in supporting the physical health of consumers experiencing mental illness is becoming more widely recognised given the importance of lifestyle interventions for physical health. The present study aimed to explore the dietitian role in mental health services as well as identify barriers and enablers to service delivery. This was a cross-sectional survey of dietitians currently employed in any capacity in public and private mental health services. An online survey comprised of questions pertaining to four domains, including demographics, role and service provision, experience and supervision, barriers/challenges and drivers/enablers was completed and included closed and open-ended responses. In total, 48 responses were included. The mean ± SD age of respondents was 36.1 ± 10.9 years (range 23-67 years) with the majority working in inpatient settings. The top three tasks respondents reported conducting were individual consultations (n = 47; 98%), group programs (n = 23; 48%) and multidisciplinary team meetings. Barriers included a lack of awareness from others regarding a dietitian's role in mental health, and a lack of specific tools for nutrition screening. More training, resources and increased evidence base to guide practice would enable better service provision. The present study provides insights regarding the possible drivers and barriers to effective service provision for dietitians working in mental health services focusing on the local contexts of respondents. The findings highlight the importance and value of working collaboratively within a multidisciplinary team.

Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries.

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians' perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians' reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p < 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition's clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media.

Defining the Practice of Dietitians in Malaysia Using the Nutrition Care Process in Patients with Type 2 Diabetes Mellitus

(1) Background: The quality of dietetic care is crucial to improve patient outcomes. The aim of this study was to measure the current practices regarding the provision of nutrition care in type 2 diabetes mellitus (T2DM) among dietitians in Malaysia. (2) Methods: A 49-item online survey was distributed via Malaysian Dietitians’ Association and Ministry of Health Malaysia social media platforms. Self-reported dietetic practices in the management of T2DM were evaluated against practice guidelines. (3) Results: A total of 173 dietitians completed the survey, with a response rate of 62%. Three-quarters of dietitians in the public sector consulted patients within two to three weeks or more than four weeks versus less than two weeks (86.3%) among private dietitians (p-value &lt; 0.001). More than 95% of private dietitians spent 31–60 min or more than 60 min on new cases versus 71% among public dietitians (p-value &lt; 0.001). Group counseling was only practiced among public dietitians (36.0%). Different practice settings led to the current findings. A limited use of behavioral counseling theories and strategies was observed among dietitians from both sectors. Limited adherence to nutrition-related recommendations (62.8%) and lack of readiness for diet/lifestyle changes (45.5%) were the key challenges faced by dietitians when managing T2DM. (4) Conclusions: The survey indicates that there is a need for the development of comprehensive training to increase the utilization of behavioral counselling. Practice setting is an element to consider when designing training.

A realist evaluation of a community of practice for dietitians and nutritionists working in Aboriginal and Torres Strait Islander health.

Communities of practice have been proposed as a workforce development strategy for developing dietitians, yet little is known about how they work and for whom, as well as under what circumstances. We aimed to understand the mechanisms by which dietitians working in Aboriginal and Torres Strait Islander health benefit from communities of practice. A realist evaluation of 29 interviews with non-Indigenous dietitians and nutritionists was employed, which was conducted over the course of two communities of practice (2013 and 2014) and follow-up interviews in 2019. Programme theory was developed from analysis of initial interviews and used to recode all interviews and test theory. The identification of patterns refined the programme theory. Six refined theories were identified: (1) a community of practice fosters the relationships that support navigation of the many tasks required to becomemore responsive health professionals; (2) committed and open participants feel supported and guided to be reflexive; (3) sharing, reflexivity, feedback and support shift awareness to one's own practice to be able to manoeuvre in intercultural spaces; (4) through sharing, feedback, support and collaboration, participants feel assured and affirmed; (5) connection through feelings of understanding and being understood contributes to commitment to remain working in the area; and (6) through sharing, feedback, support and collaboration, participants with varied experience and roles see the value of and gain confidence in new perspectives, skills and practices. Further research is required to test this model on a much larger scale, with communities of practice inclusive of Aboriginal and non-Aboriginal health professionals together, and across a diverse group of dietitians.

What are dietitians prescribing? An evaluation of the prescribing practice of a nutrition support dietitian

Background In 2016, registered dietitians in the UK were granted supplementary prescribing rights. There is currently little published data on the prescribing practices of dietitians. Aim The prescribing practice of a nutrition support dietitian specialising in intestinal rehabilitation was evaluated. Methods Over a six-month period, the dietitian collected data on her prescribing practice using the hospital proforma and then transferred the information to Excel. Findings Over a 6 month period, the dietitian prescribed for 24 patients. The most common prescriptions included parenteral nutrition, intravenous fluids and electrolytes, oral rehydration solutions and micronutrients. Medications deprescribed included codeine phosphate, loperamide, lansoprazole, forceval and folic acid. Conclusion The evaluation demonstrated that a nutrition support dietitian was able to prescribe a range of different medications related to the nutritional management of patients with intestinal failure. Further work is required to assess patient satisfaction, economic impact and attitude of other healthcare professionals.

Use of SmartIRB Does Not Reduce IRB Review Time in a Non-federally Funded, Multi-Site Malnutrition Study

ObjectivesWe evaluated the efficiency of using the SmartIRB platform compared to other site IRB approval mechanisms in the multi-site Academy and ASPEN Indicators to Diagnose Malnutrition (AAIM) Validation and Staffing Optimization Study.MethodsProcess data on the time to execute reliance agreements were collected when on-boarding sites for the AAIM Study (ClinicalTrials.gov: NCT03928548). Acute care hospital site recruitment occurred from September 2018 to December 2021. Research sites joined the study by either executing a reliance agreement with the single IRB of Record (sIRB) or by obtaining full local IRB approval from their institution. Reliance agreements were established through the SmartIRB model, an IRB authorization agreement (IAA), or a Letter of Support. Data are presented descriptively as number of observations and respective percentages or means ± standard deviations (SD).ResultsAs of September 2021, 82 sites received IRB approval for the AAIM Study through the submission of 69 individual IRB applications. Sixty sites were affiliated with SmartIRB. Forty-one applications established a reliance agreement with the sIRB: 31 of 69 used the SmartIRB model (44.9%), 7 used an IAA (10.1%), and 3 used a Letter of Support (4.3%). Twenty-eight applications were submitted for full local review (40.6%). For all 69 submissions, the average time from the initial contact to site activation by the sIRB was 496.9 ± 213.6 (SD) days. SmartIRB had the longest review period of 546.1 ± 220 days; followed by full local review (492.6 ± 213.9 days), then IAA (377.4 ± 143.7 days), and Letter of Support (306.3 ± 58.2 days).ConclusionsThe use of an sIRB and the SmartIRB platform did not to reduce the time required for IRB review of this non-federally funded study. These findings should be interpreted acknowledging several disruptions to IRB activity during the study recruitment timeframe (e.g., accelerated implementation of single IRB review starting in 2018, Common Rule changes in 2019, and the COVID-19 pandemic starting in 2020).Funding SourcesThe AAIM Study was funded by the Academy of Nutrition and Dietetics Foundation, the Commission on Dietetic Registration, the Pediatric Nutrition Practice Group, the Clinical Nutrition Management Dietetic Practice Group, and the Renal Dietitians Practice Group.

The Use of Indirect Calorimetry in Nutrition Therapy and Its Impact on Clinical Outcomes in Critically ill Patients: A review

Adequate “nutritional support is an essential element for achieving favorable outcomes in critically ill patients, which requires an accurate evaluation of energy needs to avoid under or overfeeding.” Energy requirements of critically ill patients can be assessed either by Predictive equations (PEs) or by “indirect calorimetry(IC) measurements.” However, assessment of energy expenditure (EE) is a challenging task in intensive care unit patients” because EE during critical illness is widely variable and the current PEs are inaccurate to determine the caloric requirement in these patients.” Currently, IC is considered a gold standard for measuring EE as recommended by guidelines.” Despite being the most accurate method of measuring EE, adequate data are lacking to validate the beneficial effects of IC-guided nutrition therapy on clinical outcomes in critically ill patients. Because of this, the actual clinical benefits of IC are poorly appreciated, and it is still an underutilized tool among dietitians in clinical practice.” Therefore, in many centers, PEs are commonly used instead. The purpose of this review is to summarize the findings of recent studies regarding IC-guided nutrition therapy and its impact on clinical outcomes in critically ill patients.

Nutrition Care Practices of Dietitians and Oral Health Professionals for Oral Health Conditions: A Scoping Review.

Background: Oral health conditions, such as dental caries, pose a substantial burden worldwide. Although there are many risk factors for poor oral health, diet is often implicated as a cause of these issues. The purpose of this scoping review was to identify and map studies that have captured information on the “real-world” nutrition care practices of oral health professionals (OHPs) and dietitians to optimize oral health, and specifically the dentition and periodontium. Methods: A search of peer-reviewed articles was conducted using MEDLINE, CINAHL, and Embase. Articles that addressed the review objective and met the following criteria were included: English language, published since 2000, and study conducted in a high-income country. Results: Overall, 70 articles were included. Most articles reported on cross-sectional survey studies and provided self-reported data on OHP practices; few articles reported on dietitians. Most articles reported only general/unspecific information on assessment and intervention practices, such as dietary analysis, nutrition counselling, and diet advice, and lacked specific information about the care provided, such as the dietary assessment tools used, type of information provided, and time spent on these activities. Barriers to the provision of nutrition care by OHPs were common and included time and lack of remuneration. Few studies reported on collaboration between dietitians and OHPs. Conclusions: Several studies have captured self-reported information on nutrition care practices of OHPs related to oral health; however, there is limited information available on the details of the care provided. Few studies have examined the practices of dietitians.