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Long JM, Yoder A, Woodcock L, Papoutsakis C. Impact of a Registered Dietitian Nutritionist-Led Food as Medicine Program in the Food Retail Setting: A Feasibility Study. J Acad Nutr Diet 2024:S2212-2672(24)00543-4. [PMID: 39004303 DOI: 10.1016/j.jand.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Food as medicine (FAM) interventions have been associated with improved health outcomes. However, there is limited FAM evidence in food retail settings. OBJECTIVE The objective was to evaluate the feasibility of a registered dietitian nutritionist-led FAM program that aims to detect changes in participants' nutrition problems and related nutrition and health outcomes, as documented by the Nutrition Care Process framework. DESIGN The study was a descriptive feasibility nutrition intervention cohort analysis. PARTICIPANTS SETTING A convenience sample of online food shoppers were enrolled in collaboration with a food retail chain (n = 39 participants completed the intervention and were included in primary analyses). INTERVENTION Participants received nutrition care for 6 months either in person or via telehealth. The FAM intervention included tailored nutrition care that integrated software-generated meal plans and food shopping lists to support online food shopping. MAIN OUTCOME MEASURES Progress of nutrition problems and diet quality (assessed via the Picture your Plate survey) were measured. Measurements included changes in anthropometric and biochemical parameters, blood pressure, and quality of life (assessed via the Centers for Disease Control and Prevention's Health Related Quality of Life-14 survey). STATISTICAL ANALYSES PERFORMED Mann-Whitney U test, Pearson's χ2, and Wilcoxon signed-rank tests were used to detect differences. RESULTS The most prevalent nutrition problems demonstrated improvement rates as follows: excessive energy intake, 81% (n = 21 of 26); excessive carbohydrate intake, 88% (n = 7 of 8); and obesity, 100% (n = 5 of 5). Exposure to the FAM intervention improved dietary quality, quality of life, body weight, waist circumference, and systolic pressure. CONCLUSIONS FAM interventions can be carried out by in-store registered dietitian nutritionists in the supermarket setting. This feasibility study highlighted the need and opportunity for larger studies in which registered dietitian nutritionist-led FAM interventions, in collaboration with food retailers, may improve people's nutrition and health.
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Affiliation(s)
- Julie M Long
- Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Allison Yoder
- Academy of Nutrition and Dietetics Foundation, Chicago, Illinois
| | | | - Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
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Aurélien C, Isabelle C, Ludivine S. Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital. J Hum Nutr Diet 2024; 37:593-600. [PMID: 38268332 DOI: 10.1111/jhn.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. METHODS The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. RESULTS The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. CONCLUSION EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.
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Affiliation(s)
- Clerc Aurélien
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Nutrition and Dietetics, University Training Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - Carrard Isabelle
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
| | - Soguel Ludivine
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Teaching, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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Manaf ZA, Rosli MHM, Noor NM, Jamil NA, Mazri FH, Shahar S. Exploring dietitians' views on digital nutrition educational tools in Malaysia: a qualitative study. Nutr Res Pract 2024; 18:294-307. [PMID: 38584814 PMCID: PMC10995771 DOI: 10.4162/nrp.2024.18.2.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND/OBJECTIVES Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians' perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools. SUBJECTS/METHODS A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software. RESULTS Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system. CONCLUSION Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.
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Affiliation(s)
- Zahara Abdul Manaf
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Mohd Hafiz Mohd Rosli
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
- Dietetics Unit, Kapar Health Clinic, Ministry of Health, 42200 Klang, Malaysia
| | - Norhayati Mohd Noor
- Pusat Genius @ Pintar, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia
| | - Nor Aini Jamil
- Dietetic Program and Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Fatin Hanani Mazri
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Program and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Thakur S, Gauniyal M, Bhargava S, Joshi A, Chitme H, Singhal M. Designing and evaluating a Nutritional Assessment and Intervention Kiosk for mother-child dyad to combat double burden of malnutrition. Int J Food Sci Nutr 2024; 75:227-238. [PMID: 38213010 DOI: 10.1080/09637486.2024.2303024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
The study protocol focuses on DBM, proposing a preventive strategy for mother-child pairs that would be accessible, affordable, sustainable, and human-centred. The aim is to guide the development of tools and technologies, passing through stages for gathering a process and presenting health data. The initial stage identifies the rules and models synthesising existing digital interventions combating forms of malnourishment, followed by designing and developing a Nutrition Informatics Intervention, i.e. NAIK. The last stage includes evaluation of the effectiveness and utility of NAIK. The system aims to address malnutrition by assessing different associated elements, with the participants. An SMS system will provide follow-up assistance. Overall, this study is an amalgamation of technology, data collection, personalised interventions, growth monitoring, and education to address malnutrition effectively by promoting positive health-behaviours within the community. So, a computerised health kiosk will help provide preventive strategies from the healthcare professional, especially in circumstances requiring immediate attention.
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Affiliation(s)
- Shyamli Thakur
- School of Pharmaceutical & Population Health Informatics, DIT University, Dehradun, India
| | - Mansi Gauniyal
- Foundation of Healthcare Technologies Society, Chennai, India
| | - Samir Bhargava
- School of Pharmaceutical & Population Health Informatics, DIT University, Dehradun, India
| | - Ashish Joshi
- Foundation of Healthcare Technologies Society, Chennai, India
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - H Chitme
- School of Pharmaceutical & Population Health Informatics, DIT University, Dehradun, India
| | - Manmohan Singhal
- School of Pharmaceutical & Population Health Informatics, DIT University, Dehradun, India
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Johnson SA, Kirkpatrick CF, Miller NH, Carson JAS, Handu D, Moloney L. Saturated Fat Intake and the Prevention and Management of Cardiovascular Disease in Adults: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2023; 123:1808-1830. [PMID: 37482268 DOI: 10.1016/j.jand.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States and globally and is largely attributable to atherosclerosis. Evidence indicates that multiple dietary components contribute to the complex causes of CVD and associated events and mortality. Public health authorities and scientific organizations have recommended reduced saturated fatty acid (SFA) intake for decades to promote cardiovascular health, which is linked to favorable impacts on established and emerging atherosclerotic CVD risk factors. Recently, a debate has emerged about whether SFA intake should be reduced for CVD prevention, which has contributed to confusion among health care professionals, including registered dietitian nutritionists (RDNs), and the general public, and necessitates the critical evaluation of the evidence. The objective of this evidence-based nutrition practice guideline is to provide health care and public health professionals, particularly RDNs, with evidence-based recommendations on how to address SFA intake in adults within an individualized healthy dietary pattern. Moderate evidence supports the reduction of SFA intake for CVD event reduction, low- to moderate-certainty evidence supports prioritization of replacement of SFAs with polyunsaturated fatty acids, and low-certainty evidence supports focusing on reducing the total amount of SFA rather than specific food sources of SFA. Guideline implementation should include consideration of individual preferences; principles of inclusion, diversity, equity, and access; and potential nutritional deficiencies that may occur with reduced SFA intake. Future research is needed to address gaps that were identified and provide high-quality evidence to support stronger future recommendations based on the relationship between SFA and CVD.
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Heitman K, Proaño GV, Papoutsakis C, Diaque Ballesteros P, Steiber A, Taylor CA. Learning Outcomes From a Virtual Nutrition Care Process Workshop Delivered to Nutrition and Dietetics Professionals in Mexico. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Colin CR, Woodcock L, Wright LY, Yakes Jimenez E, Papoutsakis C. The Need for and Challenges of Nutrition and Dietetics Registry Studies: An Update on the Academy of Nutrition and Dietetics Health Informatics Infrastructure. J Acad Nutr Diet 2023; 123:673-682. [PMID: 36623691 DOI: 10.1016/j.jand.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Casey R Colin
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | | | - Lauri Y Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Elizabeth Yakes Jimenez
- Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; College of Population Health, University of New Mexico, Albuquerque, New Mexico
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Colin C, Arikawa A, Lewis S, Cooper M, Lamers-Johnson E, Wright L, Papoutsakis C. Documentation of the evidence-diagnosis link predicts nutrition diagnosis resolution in the Academy of Nutrition and Dietetics' diabetes mellitus registry study: A secondary analysis of Nutrition Care Process outcomes. Front Nutr 2023; 10:1011958. [PMID: 36969819 PMCID: PMC10034103 DOI: 10.3389/fnut.2023.1011958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesTo describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution.MethodsThis is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model.ResultsThe most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30–6.02; p = 0.008).ConclusionMost diagnoses were caused by patients' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.
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Affiliation(s)
- Casey Colin
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Andrea Arikawa
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Sherri Lewis
- James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Melissa Cooper
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | | | - Lauri Wright
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Constantina Papoutsakis
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- *Correspondence: Constantina Papoutsakis
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Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) in primary care: A mixed-method survey of healthcare consumers and professionals. J Hum Nutr Diet 2023; 36:311-322. [PMID: 35822586 PMCID: PMC10087511 DOI: 10.1111/jhn.13065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evidence-based models are effective tools for informing quality improvement activities in health care. The Quality in Nutrition Care (QUINCE) model is an evidence-based model that describes quality nutrition care in the primary care setting but has not been applied to primary care dietetics. The present study comprised two phases. In the first phase, the study aimed to evaluate and compare healthcare consumers and professional perspectives on the importance of the 10 statements to understand their relevance for dietetics care. In the second phase, the study aimed to test and enhance the QUINCE model using healthcare consumer and professional responses to statements that were identified as relevant to primary care dietetics in the first phase. METHODS Quantitative and qualitative data were collected using an online survey comprising statements describing quality dietetic care adapted from the complexity literature. Quantitative data were analysed using descriptive statistical analysis to investigate statement importance as rated by participants using a six-point Likert scale. Qualitative content analysis was performed on the qualitative data using a deductive-inductive approach to identify patterns in the data. The QUINCE model was compared with identified patterns and modified as appropriate. RESULTS One hundred and fourteen consumers and 107 primary care professionals agreed on the importance of seven statements but expressed divergent views on the remaining three statements that addressed: (1) access to medical records; (2) access to performance and safety information; and (3) variation in care between dietitians. The QUINCE model was modified to produce the Quality in Nutrition Care Model for Dietitians (QUINCE-MOD) describing quality dietetic care in the primary care setting. CONCLUSIONS Consumers and professionals share views on some aspects of quality dietetic care but diverge on other aspects. The QUINCE-MOD is an evidence-based, complexity-informed model that describes components of quality relevant to primary care dietetics. The model should be applied at the practice level to reflect the unique perspective of quality at that level.
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Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
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Guest DD, Cox T, Voss AC, Kelley K, Ma X, Nguyen A, McMillen K, Williams V, Lee JA, Petersen J, Lenning K, Jimenez EY. Assessing Impact of Nutrition Care by Registered Dietitian Nutritionists on Patient Medical and Treatment Outcomes in Outpatient Cancer Clinics: A Cohort Feasibility Study. Nutr Cancer 2023; 75:923-936. [PMID: 36691979 PMCID: PMC10029747 DOI: 10.1080/01635581.2023.2170431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
More information is needed about the impact of outpatient nutrition care from a registered dietitian nutritionist (RDN) on patient outcomes. This study aimed to assess the feasibility of a cohort study design to evaluate impact of RDN nutrition care on patient outcomes, describe clinic malnutrition screening practices, and estimate statistical parameters for a larger study. Seventy-seven patients with lung, esophageal, colon, rectal, or pancreatic cancer from six facilities were included (41 received RDN care and 36 did not). RDN nutrition care was prospectively documented for six months and documented emergency room visits, unplanned hospitalizations and treatment changes were retrospectively abstracted from medical records. Most facilities used the Malnutrition Screening Tool (MST) to determine malnutrition risk. Patients receiving RDN care had, on average, five, half hour visits and had more severe disease and higher initial malnutrition risk, although this varied across sites. Documented medical and treatment outcomes were relatively rare and similar between groups. Estimated sample size requirements varied from 113 to 5856, depending on tumor type and outcome, and intracluster correlation coefficients (ICCs) ranged from 0 to 0.47. Overall, the methods used in this study are feasible but an interventional or implementation design might be advantageous for a larger study.
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Affiliation(s)
- Dolores D. Guest
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Tricia Cox
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Kathryn Kelley
- Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | | | | | - James A. Lee
- Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | | | - Elizabeth Yakes Jimenez
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, IL, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Lamers-Johnson E, Kelley K, Knippen KL, Feddersen K, Sánchez DM, Parrott JS, Colin C, Papoutsakis C, Jimenez EY. A quasi-experimental study provides evidence that registered dietitian nutritionist care is aligned with the Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines for type 1 and 2 diabetes. Front Nutr 2022; 9:969360. [PMID: 36172522 PMCID: PMC9511164 DOI: 10.3389/fnut.2022.969360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background One previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG). Objectives To describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics' EBNPG for Type 1 and Type 2 diabetes and examine impact of a midpoint training on care alignment with the guideline. Methods In this 2-year, quasi-experimental study, 19 RDNs providing outpatient medical nutrition therapy to adults with diabetes (n = 562) documented 787 initial and follow-up encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores. Results Most patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85 and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training (n = 19 RDNs, 519 encounters pre-training; n = 14 RDNs, 204 encounters post-training; β = −0.06, SE = 0.04; 95% CI: −0.14, 0.03). Conclusions Most RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.
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Affiliation(s)
- Erin Lamers-Johnson
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- *Correspondence: Erin Lamers-Johnson
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Kerri Lynn Knippen
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH, United States
| | | | - Damien M. Sánchez
- Organization, Information, and Learning Sciences, University of New Mexico, Albuquerque, NM, United States
| | - J. Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Blackwood, NJ, United States
| | - Casey Colin
- Nutrition and Dietetics Department, University of North Florida, Jacksonville, FL, United States
| | | | - Elizabeth Yakes Jimenez
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico, Albuquerque, NM, United States
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Proaño GV, Papoutsakis C, Lamers-Johnson E, Moloney L, Bailey MM, Abram JK, Kelley K, Steiber A, McCabe GP, Myaskovsky L, Jimenez EY. Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol. J Ren Nutr 2022; 32:613-625. [PMID: 34728124 PMCID: PMC9733590 DOI: 10.1053/j.jrn.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/13/2022] Open
Abstract
Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian.
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Affiliation(s)
- Gabriela V Proaño
- Senior Research Project Manager, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | | | | | - Lisa Moloney
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Mary M Bailey
- Research Consultant, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Jenica K Abram
- Manager, Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Kathryn Kelley
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Chief Science Officer, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - George P McCabe
- Professor Emeritus of Statistics, Purdue University, West Lafayette, Illinois
| | - Larissa Myaskovsky
- Professor, Department of Internal Medicine, Director, Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Elizabeth Yakes Jimenez
- Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Director, Nutrition Research Network, Academy of Nutrition and Dietetics, Albuquerque, New Mexico
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Braun A, Hill E, Gallo S, Landry MJ, Vitolins M, Papoutsakis C, Jimenez EY, Rozga M. Research at the Academy of Nutrition and Dietetics: What, How, and Why? J Acad Nutr Diet 2022; 122:2150-2162. [PMID: 35998865 DOI: 10.1016/j.jand.2022.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics professionals to create and provide evidence-based interventions, including medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs). Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (e.g., Nutrition Research Network (NRN) and Data Science Center (DSC)), tools to aggregate practice data (Nutrition Care Process and Terminology (NCPT) and the Academy of Nutrition and Dietetics Informatics Infrastructure (ANDHII)), funding opportunities to support primary research (e.g., Academy Foundation), resources to understand the latest research informing evidence-based practice (EBP) (e.g., Evidence Analysis Center (EAC)), and avenues for sharing research findings (e.g., Food and Nutrition Conference and Expo (FNCE)). The aim of this paper is to encourage members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.
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Affiliation(s)
- Ashlea Braun
- Assistant Professor, Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, 312 Nancy Randolph Davis, Stillwater, OK 74078-6141.
| | - Emily Hill
- Postdoctoral Fellow, Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mailstop F-561 Aurora, CO 80045.
| | - Sina Gallo
- Associate Professor, Nutritional Sciences, University of Georgia, 305 Sanford Drive, suite 209, Athens, GA 30602.
| | - Matthew J Landry
- Postdoctoral Fellow, Stanford Prevention Research Center, School of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA 94304.
| | - Mara Vitolins
- Professor, Wake Forest School of Medicine, Department of Epidemiology and Prevention, Medical Center Boulevard, Winston-Salem, NC 27157.
| | - Constantina Papoutsakis
- Senior Director, Nutrition and Dietetics Data Science Center, Research, International and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
| | - Elizabeth Yakes Jimenez
- Director, Nutrition Research Network, Academy of Nutrition and Dietetics , 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health , University of New Mexico Health Sciences Center , 2211 Lomas Blvd NE, Albuquerque, NM 87106.
| | - Mary Rozga
- Nutrition Researcher II, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
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14
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Lewis SL, Miranda LS, Kurtz J, Larison LM, Brewer WJ, Papoutsakis C. Nutrition Care Process Quality Evaluation and Standardization Tool: The Next Frontier in Quality Evaluation of Documentation. J Acad Nutr Diet 2021; 122:650-660. [PMID: 34463620 DOI: 10.1016/j.jand.2021.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Documentation is essential for communicating care between credentialed nutrition and dietetics practitioners and other health care providers. A validated tool that can evaluate quality documentation of the Nutrition Care Process (NCP) encounter, including progress on outcomes is lacking. The aim of the NCP Quality Evaluation and Standardization Tool (QUEST) validation study is to revise an existing NCP audit tool and evaluate it when used within US Veterans Affairs in all clinical care settings. Six registered dietitian nutritionists revised an existing NCP audit tool. The revised tool (NCP-QUEST) was analyzed for clarity, relevance, and reliability. Eighty-five documentation notes (44 initial, 41 reassessment) were received from eight volunteer Veterans Affairs sites. Five of six registered dietitian nutritionists participated in the interrater reliability testing blinded to each other's ratings; and two registered dietitian nutritionists participated in intrarater reliability reviewing the same notes 6 weeks later blinded to the original ratings. Results showed moderate levels of agreement in interrater reliability (Krippendorff's α = .62 for all items, .66 for total score, and .52 for quality category rating). Intrarater reliability was excellent for all items (α = .86 to .87 for all items; .91 to .94 for total score and.74 to .89 for quality category rating). The NCP-QUEST has high content validity (Content Validity Index = 0.78 for item level, and 0.9 for scale level) after two cycles of content validity review. The tool can facilitate critical thinking, improved linking of NCP chains, and is a necessary foundation for quality data collection and outcomes management. The NCP-QUEST tool can improve accuracy and confidence in charting.
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Need and Importance of Nutrition Informatics in India: A Perspective. Nutrients 2021; 13:nu13061836. [PMID: 34072133 PMCID: PMC8230128 DOI: 10.3390/nu13061836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Nutrition informatics (NI) is the effective retrieval, organization, storage, and optimum use of information, data and knowledge for food-and-nutrition-related problem-solving and decision-making. There is a growing opportunity to facilitate technology-enabled behavioral change interventions to support NI research and practice. This paper highlights the changing landscape of food and nutrition practices in India to prepare a NI workforce that could provide some valuable tools to address the double burden of nutrition. Management and interpretation of data could help clarify the relationships and interrelationships of diet and disease in India on both national and regional levels. Individuals with expertise in food and nutrition may receive training in informatics to develop national informatics systems. NI professionals develop tools and techniques, manage various projects and conduct informatics research. These professionals should be well prepared to work in technological settings and communicate data and information effectively. Opportunities for training in NI are very limited in developing countries. Given the current progress in developing platforms and informatics infrastructure, India could serve as an example to other countries to promote NI to support achieving SDGs and other public health initiatives.
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Lamers-Johnson E, Kelley K, Sánchez DM, Knippen KL, Nadelson M, Papoutsakis C, Yakes Jimenez E. Academy of Nutrition and Dietetics Nutrition Research Network: Validation of a Novel Nutrition Informatics Tool to Assess Agreement Between Documented Nutrition Care and Evidence-Based Recommendations. J Acad Nutr Diet 2021; 122:862-872. [PMID: 33903080 DOI: 10.1016/j.jand.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
More evidence regarding registered dietitian nutritionist implementation of evidence-based nutrition practice guidelines (EBNPGs) is needed. We assessed the utility of an automated informatics tool to evaluate congruence of documented nutrition care with 13 individual recommendations in the diabetes mellitus (DM) EBNPG and with the guideline overall. A concurrent validation study was conducted using Nutrition Care Process Terminology documentation entered in the Academy of Nutrition and Dietetics Health Informatics Infrastructure by registered dietitian nutritionists caring for patients with DM. A 15% subset (n = 115) of the 790 patient encounters recorded were selected randomly, and the documented care was evaluated using the automated DM Expected Care Plan (ECP) Analyzer and expert audit. Recommendation-level congruence, as determined by each method, was compared using Cohen's κ analysis, and the accuracy, sensitivity, and specificity of the DM ECP Analyzer for assessing overall guideline-level congruence was calculated with expert audits as the "gold standard." For recommendation-level congruence, the DM ECP Analyzer identified more instances of recommendation implementation in the patient encounters, and classified more encounters as including partial or full recommendation implementation for 10 of the 13 recommendations, compared with the expert audit. There was slight to fair agreement between the DM ECP and the expert audit for most individual recommendations, with a mean ± standard deviation level of agreement of κ = .17 ± .19 across all eligible recommendations. At the guideline level, the DM Analyzer had high accuracy (98.3%) and sensitivity (99.1%) and low specificity (0%; no true negatives detected). The DM ECP Analyzer is acceptable for conducting automated audits of nutrition documentation to assess congruence of documented care with recommendations for evidence-based care. Future changes to the EBNPG, Nutrition Care Process Terminology, Academy of Nutrition and Dietetics Health Informatics Infrastructure, and the DM ECP Analyzer could potentially improve recommendation-level performance. The DM ECP Analyzer can be modified for other EBNPGs to facilitate automated assessment of guideline implementation.
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Maduri C, Sabrina Hsueh PY, Li Z, Chen CH, Papoutsakis C. Applying Contemporary Machine Learning Approaches to Nutrition Care Real-World Evidence: Findings From the National Quality Improvement Data Set. J Acad Nutr Diet 2021; 121:2549-2559.e1. [PMID: 33903081 DOI: 10.1016/j.jand.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
Using real-world data from the Academy of Nutrition and Dietetics Health Informatics Infrastructure, we use state-of-the-art clustering techniques to identify 2 phenotypes characterizing the episodes of nutrition care observed in the National Quality Improvement (NQI) registry data set. The 2 phenotypes identified from recorded Nutrition Care Process data in the NQI exhibit a strong correspondence with the clinical expertise of registered dietitian nutritionists. For one of these phenotypes, it was possible to implement state-of-the-art classification techniques to predict the nutrition problem-resolution status of an episode of care. Prediction results show that the assessment of nutrition history, number of recorded visits in the episode, and use of nutrition counseling interventions were significantly and positively correlated with problem resolution. Meanwhile, evaluations of nutrition history that were not within the desired ranges were significantly and negatively correlated with problem resolution. Finally, we assess the usefulness of the current NQI data set and data model for supporting the application of contemporary machine learning methods to the data set. We also suggest ways of enhancing the NQI since registered dietitian nutritionists are encouraged to continue to contribute patient cases in this and other registry nutrition studies.
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Affiliation(s)
- Chandramouli Maduri
- Watson Health Foundational Technology, IBM Cloud and Cognitive Software, Yorktown Heights, NY
| | - Pei-Yun Sabrina Hsueh
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Zhiguo Li
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Ching-Hua Chen
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Constantina Papoutsakis
- Nutrition and Dietetics Data Science Center, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.
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Martins C, Saeki SL, do Nascimento MM, Lucas FM, Vavruk AM, Meireles CL, Justino S, Mafra D, Rabito EI, Schieferdecker MEM, Campos LF, van Aanholt DPJ, Hordonho AA, Fidelix MSP. Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease. J Bras Nefrol 2021; 43:236-253. [PMID: 33836040 PMCID: PMC8257272 DOI: 10.1590/2175-8239-jbn-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022] Open
Abstract
This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
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Affiliation(s)
- Cristina Martins
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Grupo de Trabalho Internacional da NCPT, Subcomitê Internacional da
Academy of Nutrition and Dietetics (Academy) para a TPCN, Curitiba, PR,
Brasil
- Instituto Cristina Martins de Educação e Pesquisa em Saúde,
Curitiba, PR, Brasil
| | - Simone L. Saeki
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Instituto Cristina Martins de Educação e Pesquisa em Saúde,
Curitiba, PR, Brasil
| | - Marcelo Mazza do Nascimento
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fernando M. Lucas
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais/Grupo
Nefroclínicas, Belo Horizonte, MG, Brasil
| | - Ana Maria Vavruk
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Hospital e Maternidade Municipal de São José dos Pinhais, São José
dos Pinhais, PR, Brasil
| | - Christiane L. Meireles
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- University of Texas Health Science Center, School of Nursing, San
Antonio, USA
| | - Sandra Justino
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Complexo do Hospital de Clínicas da
UFPR, Curitiba, PR, Brasil
| | - Denise Mafra
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil
| | - Estela Iraci Rabito
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | - Denise P. J. van Aanholt
- Sociedade Brasileira de Nutrição Parenteral e Enteral, Curitiba, PR,
Brasil
- Federación Latinoamericana de Terapia Nutricional, Nutrición
Clínica y Metabolismo, Ecuador
| | - Ana Adélia Hordonho
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Estadual de Ciências da Saúde, Hospital Escola Hélvio
Auto e Hospital Metropolitano de Alagoas, Maceió, AL, Brasil
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Ansu V, Papoutsakis C, Gletsu-Miller N, Spence LA, Kelley K, Woodcock L, Wallace TC, Steiber A. Nutrition care practice patterns for patients with COVID-19-A preliminary report. JPEN J Parenter Enteral Nutr 2021; 45:1774-1778. [PMID: 33728687 PMCID: PMC8250241 DOI: 10.1002/jpen.2106] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 is a respiratory virus that poses risks to the nutrition status and survival of infected patients, yet there is paucity of data to inform evidence‐based quality care. Methods We collected data on the nutrition care provided to patients with coronavirus disease 2019 (COVID‐19) by registered dietitian nutritionists (RDNs). Results Hospitalized COVID‐19 patients (N = 101) in this cohort were older adults and had elevated body mass index. The most frequent nutrition problems were inadequate oral intake (46.7%), inadequate energy intake (18.9%), and malnutrition (18.4%). These problems were managed predominantly with enteral nutrition, food supplements, and multivitamin‐multimineral supplement therapy. Over 90% of documented problems required a follow‐up. Conclusion This data set is the first of its kind to report on the types of nutrition diagnoses and interventions for COVID‐19 cases used by RDNs and highlights the need for increased and continued nutrition care.
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Affiliation(s)
- Velarie Ansu
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Nana Gletsu-Miller
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Lisa A Spence
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | | | - Taylor C Wallace
- Think Healthy Group, Washington, District of Columbia, USA.,Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA.,Center for Magnesium Education & Research, Pahoa, Hawaii, USA
| | - Alison Steiber
- Academy of Nutrition and Dietetics, Chicago, Illinois, USA.,Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
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20
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Mujlli G, Aldisi D, Aljuraiban GS, Abulmeaty MMA. Impact of Nutrition Care Process Documentation in Obese Children and Adolescents with Metabolic Syndrome and/or Non-Alcoholic Fatty Liver Disease. Healthcare (Basel) 2021; 9:healthcare9020188. [PMID: 33572340 PMCID: PMC7916099 DOI: 10.3390/healthcare9020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the Nutrition Care Process documentation used by dietitians for obese pediatric patients diagnosed with metabolic syndrome (MetS) and/or non-alcoholic fatty liver disease (NAFLD) and its impact on the achievement of nutritional goals. This retrospective cohort study utilized data retrieved from three tertiary care hospitals in Riyadh. A total of 142 obese pediatric patients aged 8–18 years diagnosed with NAFLD and/or MetS were evaluated. Data on weight, height, blood pressure (BP), lipid profile, and liver enzymes were collected. A validated audit was used to assess the documentation quality. Twenty-seven (46.6%) dietitian notes received a high score, 21 (36.2%) received a medium score, and 10 (17.2%) received a low score. There was no significant effect of dietitian audit scores on nutritional outcomes, however, the change in body mass index from 6 to 12 months follow-up period was inversely correlated with the audit score (r = −0.761, p = 0.007), and alkaline phosphatase was inversely correlated with the audit score (r = −0.819, p = 0.013). In conclusion, there was a clear variation in the quality of dietitians’ documentation and the impact of documentation scores on nutritional outcomes.
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Affiliation(s)
- Gadah Mujlli
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
- Education, Simulation and Skills Development Center, Princess Nourah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Dara Aldisi
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
| | - Ghadeer S. Aljuraiban
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
| | - Mahmoud M. A. Abulmeaty
- Clinical Nutrition Program, Community Health Department, King Saud University, Riyadh 11362, Saudi Arabia; (G.M.); (D.A.); (G.S.A.)
- Obesity Management and Research Unit, Medical Physiology Department, Zagazig University, Zagazig 44519, Egypt
- Correspondence: ; Tel.: +96-65-4815-5983
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21
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Murphy WJ, Hand RK, Abram JK, Papoutsakis C. Impact of Diabetes Prevention Guideline Adoption on Health Outcomes: A Pragmatic Implementation Trial. J Acad Nutr Diet 2020; 121:2090-2100.e1. [PMID: 33279465 DOI: 10.1016/j.jand.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Abstract
Limited research exists to evaluate nutrition guideline impact on clinical practice and patient health outcomes. In this study we investigate (1) the impact of guideline training on the implementation of the diabetes prevention Evidence-Based Nutrition Practice Guideline (EBNPG), and (2) the relationship between EBNPG congruence and resulting health outcomes in patients with prediabetes. We conducted an implementation study in which registered dietitian nutritionists (RDNs) provided nutrition care with 3-month follow-up to 102 pre-diabetes patients before and after a professional training on the implementation of the Diabetes Prevention EBNPG. Using the RDNs' Nutrition Care Process (NCP) documentation, we measured percent guideline congruence and health outcomes (body weight, waist circumference, fasting glucose, glycosylated hemoglobin), and modeled health outcomes. Guideline congruence improved after training by 4.3% (P < 0.05). However, no significant associations were observed between guideline training, or guideline congruence and health outcomes. Our model showed a reduction in waist circumference (2.1 ± 0.92 cm; P = 0.023), and body weight (-1.78 ± 0.55 kg; P = 0.001) throughout the course of the study. Training of nutrition professionals improved congruence to EBNPG for Diabetes Prevention. Nevertheless, improved guideline congruence did not impact related health outcomes. Standard care including nutrition intervention resulted in body weight and waist circumference reductions. Future research needs to further address the impact of evidence-based guidelines on outcomes in all areas of practice.
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Affiliation(s)
- William J Murphy
- Academy of Nutrition and Dietetics, Chicago, IL; Lumere Inc, a GHX Company, Chicago, IL
| | - Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, OH; Dietetics Practice Based Research Network, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL
| | - Jenica K Abram
- Nutrition Research Network (former Dietetics Practice Based Research Network), Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL
| | - Constantina Papoutsakis
- Nutrition and Dietetics Data Science Center, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.
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22
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Murofushi K, Badaracco C, County C, Gonzales-Pacheco D, Silzle C, Watowicz R, Moloney L. Implementation Science in Evidence-based Nutrition Practice: Considerations for the Registered Dietitian Nutritionist. J Acad Nutr Diet 2020; 121:1392-1400. [PMID: 33158798 DOI: 10.1016/j.jand.2020.08.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 01/04/2023]
Abstract
Nutrition and dietetics practice should be based on the highest-quality and most recent available evidence. Unfortunately, translating research to day-to-day practice often involves long lag times. Implementation science is an emerging field that evaluates methods that promote uptake of research findings into daily practice. Numerous theories and frameworks have been developed to provide guidance for implementation research and operationalization of recommendations. This paper provides a broad overview of implementation science and highlights frameworks such as the Normalization Process Theory that can be used by registered dietitian nutritionist (RDNs) to encourage systematic uptake of evidence into practice.
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Affiliation(s)
| | | | | | - Diana Gonzales-Pacheco
- Department of Individual, Family, and Counseling Education, University of New Mexico, Albuquerque, New Mexico
| | | | - Rosanna Watowicz
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL.
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Kelly JT, Collins PF, McCamley J, Ball L, Roberts S, Campbell KL. Digital disruption of dietetics: are we ready? J Hum Nutr Diet 2020; 34:134-146. [DOI: 10.1111/jhn.12827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Affiliation(s)
- J. T. Kelly
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - P. F. Collins
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
| | - J. McCamley
- Metro North Hospital and Health Service Herston QLD Australia
| | - L. Ball
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - S. Roberts
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
- Gold Coast Hospital and Health Service Southport QLD Australia
| | - K. L. Campbell
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- Centre of Applied Health Economics School of Medicine Griffith University Southport QLD Australia
- Metro North Hospital and Health Service Herston QLD Australia
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Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans' Health Care Facility. J Acad Nutr Diet 2020; 121:1831-1840. [PMID: 32732152 DOI: 10.1016/j.jand.2020.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
In this article, we evaluate relationships between Nutrition Care Process (NCP) chain links and improvement or resolution of the nutrition diagnosis. We conducted a retrospective record review for 12 months in a single Veterans Health Administration health care system using the Veterans Health Administration-specific monitoring and evaluation terms, NCP terminology, and its etiology categories to evaluate outcomes. Logistic regression analysis revealed that the strongest predictor for diagnosis improvement was the etiology-intervention link. The odds of improving the nutrition diagnosis were 51.43 times higher when the etiology-intervention link was present. The odds of improving the nutrition diagnosis were 19.74 times higher when the evidence-diagnosis link was present and 9.46 times higher when the intervention-goal link was present. For every added nutrition visit by the registered dietitian nutritionist, the odds of improving the nutrition diagnosis increased by 32.5%. For every increased point on the NCP audit score, the odds of resolving or improving the nutrition diagnosis increased by 37.7%. When applying the NCP, the presence of the etiology-intervention link significantly improves the odds of resolving the nutrition diagnosis in a Veterans Health Administration population. For the first time, we show evidence that the NCP works as designed. Also, we demonstrate that the quality of NCP documentation impacts resolution of the diagnosis, and we describe the methodology for how to evaluate NCP outcomes. Registered dietitian nutritionists are encouraged to critically evaluate links of the NCP chain, assess NCP documentation for quality, and pursue follow-up visits to improve resolution of nutrition problems.
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Chui TK, Proaño GV, Raynor HA, Papoutsakis C. A Nutrition Care Process Audit of the National Quality Improvement Dataset: Supporting the Improvement of Data Quality Using the ANDHII Platform. J Acad Nutr Diet 2019; 120:1238-1248.e1. [PMID: 31668603 DOI: 10.1016/j.jand.2019.08.174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 10/25/2022]
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26
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Rusnak S, Charney P. Position of the Academy of Nutrition and Dietetics: Nutrition Informatics. J Acad Nutr Diet 2019; 119:1375-1382. [DOI: 10.1016/j.jand.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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27
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Noland D, Raj S. Academy of Nutrition and Dietetics: Revised 2019 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition in Integrative and Functional Medicine. J Acad Nutr Diet 2019; 119:1019-1036.e47. [DOI: 10.1016/j.jand.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 02/07/2023]
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28
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Nutrition Care Process (NCP) Update Part 2: Developing and Using the NCP Terminology to Demonstrate Efficacy of Nutrition Care and Related Outcomes. J Acad Nutr Diet 2019; 119:840-855. [DOI: 10.1016/j.jand.2018.10.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
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