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Lepre B, Mansfield KJ, Ray S, Beck EJ. Establishing consensus on nutrition competencies for medicine: a Delphi study. BMJ Nutr Prev Health 2024; 7:68-77. [PMID: 38966103 PMCID: PMC11221290 DOI: 10.1136/bmjnph-2023-000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 07/06/2024] Open
Abstract
Background Significant research, regulatory bodies and even governmental resolutions have identified meaningful nutrition education for medical and other healthcare professionals as a priority. Doctors are well placed to provide nutrition care, yet nutrition education in medicine remains inadequate regardless of country, setting, or year of training. There remains a need to establish an accepted benchmark on nutrition competencies for medicine, as without consensus standards there is little likelihood of uniform adoption. Objective This study aimed to establish consensus on nutrition competencies using a Delphi process to inform a framework for nutrition education in medicine. Methods A three-round modified online Delphi survey of experts in healthcare practice, education and training, and experts by experience (service users) was conducted to provide a comprehensive consensus on nutrition competencies for medical practice. Results Fifty-two experts (15.1% response rate) participated in Round 1, 42 completed Round 2 and 47 completed Round 3. Participants included medical professionals, dietitians, academics working in health professions education and policymakers from Australia, New Zealand, the UK and Northern Ireland. Twenty-seven service users (57.5% response rate) completed the Round 1 questionnaire, 19 completed Round 2 and 16 completed Round 3. By consensus, 25 nutrition competencies for medicine were defined. The service user panel identified an additional seven skills and attributes considered important in the receipt of nutrition care. Competencies that achieved consensus broadly fell into themes of team-based care, communication, professionalism (eg, attributes) and health promotion and disease prevention. This informs broad skills that may be taught in a nutrition context but could be included in other domains. Conclusions The findings suggest doctors need the knowledge and skills to consider the findings from nutrition screening and assessment, coordinate nutrition care when an individual may benefit from further assessment or intervention and provide support for advice delivered by other experts as part of a multidisciplinary approach.
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Affiliation(s)
- Breanna Lepre
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
- NNEdPro Global Institute for Food, Nutrition and Health St John’s Innovation Centre, NNEdPro, Cambridge, UK
| | - Kylie J Mansfield
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sumantra Ray
- NNEdPro Global Institute for Food, Nutrition and Health St John’s Innovation Centre, NNEdPro, Cambridge, UK
- Fitzwilliam College, University of Cambridge, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Eleanor J Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Beck EJ, Ball L, Lepre BM, McLean R, Wall C, Adamski M, McCarthy H, Crowley J. Now is the time to act on nutrition in medical education. Med J Aust 2023; 218:100-102. [PMID: 36625464 DOI: 10.5694/mja2.51829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/29/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Eleanor J Beck
- University of Wollongong, Wollongong, NSW.,NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK
| | - Lauren Ball
- NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK.,University of Queensland, Brisbane, QLD
| | - Breanna M Lepre
- University of Wollongong, Wollongong, NSW.,NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK
| | | | - Clare Wall
- University of Auckland, Auckland, New Zealand
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Abbott JH, Keenan R, Billing-Bullen G, Pask A, O'Brien D, Hudson B, Darlow B. Guest Editorial: Most people waiting for osteoarthritis care never get it – it’s time to try a different approach. J Prim Health Care 2022; 14:93-95. [PMID: 35771699 DOI: 10.1071/hc22063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, New Zealand
| | - Rawiri Keenan
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
| | | | - Alison Pask
- Independent Dietitian, Wellington, New Zealand
| | - Daniel O'Brien
- Auckland University of Technology, Auckland, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago Christchurch, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
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Abstract
The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
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Blair M, Mitchell L, Palermo C, Gibson S. Trends, challenges, opportunities, and future needs of the dietetic workforce: a systematic scoping review. Nutr Rev 2021; 80:1027-1040. [PMID: 34532738 DOI: 10.1093/nutrit/nuab071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Issues related to nutrition and health are prominent, yet it is unclear if the dietetics workforce is being used optimally. OBJECTIVE Trends, challenges, opportunities, and future needs of the international dietetic workforce are investigated in this review, which was registered with Open Science Framework (10.17605/OSF.IO/DXNWE). DATA SOURCES Eight academic and 5 grey-literature databases and the Google search engine were searched from 2010 onward according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Of 2050 articles screened, 184 were eligible for inclusion. DATA EXTRACTION To chart data, a directed content analysis and a constant comparison technique were used. DATA ANALYSIS The following 13 themes were identified: 1) emerging or expanding areas of practice; 2) skill development; 3) economic considerations; 4) nutrition informatics; 5) diversity within the workforce; 6) specific areas of practice; 7) further education; 8) intrapersonal factors; 9) perceptions of the profession; 10) protecting the scope of practice; 11) support systems; 12) employment outcomes; and 13) registration or credentialing. CONCLUSIONS The dietetics profession is aware of the need to expand into diverse areas of employment. Comprehensive workforce data are necessary to facilitate workforce planning.
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Affiliation(s)
- Merran Blair
- M. Blair and C. Palermo are with the Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Lana Mitchell
- L. Mitchell is with the School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Claire Palermo
- M. Blair and C. Palermo are with the Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- S. Gibson is with the School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Greenlees NT, Pit SW, Ross LJ, McCormack JJ, Mitchell LJ, Williams LT. A novel blended placement model improves dietitian students' work-readiness and wellbeing and has a positive impact on rural communities: a qualitative study. BMC MEDICAL EDUCATION 2021; 21:387. [PMID: 34273993 PMCID: PMC8286607 DOI: 10.1186/s12909-021-02756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community. METHODS An exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements (n = 14) or blended placements (n = 9). Individual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses. RESULTS The overarching theme across all blended model placements was 'enhanced work-readiness', including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme 'enhanced work-readiness': students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blended long-stay rural placements: 'increased community connections' which included additional health services delivery, deeper personal experience and more rewarding student-supervisor relationships. Thirdly, two extra themes emerged that influenced work-readiness and community impact: 'local organisational support and resources' and 'enhanced innovative and interprofessional learning opportunities'. CONCLUSIONS Blended placements enhance work-readiness skills by providing an alternative model to that commonly applied, and providing flexibility in education programs. Additionally, fully blended long-stay rural placements positively influence the local community through impacting the student experience as well as providing more dietetics services and may therefore assist in reducing dietetics workforce shortages and health inequity.
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Affiliation(s)
- Narelle T Greenlees
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
- The University of Sydney, University Centre for Rural Health, Lismore, NSW Australia
| | - Sabrina W. Pit
- The University of Sydney, University Centre for Rural Health, Lismore, NSW Australia
- NSW Rural Doctors Network, Newcastle, Australia
| | - Lynda J Ross
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Jo J McCormack
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Lana J Mitchell
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Lauren T. Williams
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Australia
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Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147430. [PMID: 34299881 PMCID: PMC8305190 DOI: 10.3390/ijerph18147430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.
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Kocanda L, Brain K, Frawley J, Schumacher TL, May J, Rollo ME, Brown LJ. The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review. J Acad Nutr Diet 2021; 121:2046-2070.e1. [PMID: 34247977 DOI: 10.1016/j.jand.2021.05.025] [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: 11/12/2020] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dietary intake is an important modifiable risk factor for cardiovascular disease. However, to our knowledge, there are no systematic reviews of nutrition interventions in the context of cardiovascular disease prevention and management within rural communities. This is important to investigate, given the unique geographic, social, and contextual factors associated with rurality. OBJECTIVE Our primary objective was to systematically assess evidence on the effectiveness of randomized controlled trials to improve dietary intake in the context of cardiovascular disease prevention and management in rural communities. METHODS Nine electronic databases were searched from inception to June 2020, including MEDLINE, The Cochrane Library, Embase, Emcare, PsycINFO, Scopus, Rural and Remote Health, CINAHL, and AMED. Randomized controlled trials that reported results of interventions with adult, rural populations and measured change in dietary intake compared to usual care, alternative intervention, or no intervention controls were included. Included randomized controlled trials were also assessed according to the TIDieR (Template for Intervention Description and Reporting) checklist and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. RESULTS Thirteen articles reporting results of randomized controlled trials were identified. Included articles reported a range of nutrition interventions and measured 18 dietary intake outcomes. Most studies (n = 10) demonstrated effectiveness in altering at least 1 dietary intake outcome, including fruit and/or vegetable (n = 9), fiber (n = 2), Dietary Risk Assessment score (n = 2), energy, dairy, carotene, vitamin C and sodium (all n = 1). However, there was wide variation in the reporting of intervention components (according to the TIDieR checklist) and impact (according to RE-AIM framework), resulting in difficulty interpreting the "real-world" implications of these results. CONCLUSIONS Through this systematic review, we found limited evidence of improvement in dietary intakes due to nutrition interventions in the context of cardiovascular disease prevention and management in rural communities. Fruit and/or vegetable intakes were the most frequently reported dietary intake outcomes, and most likely to be improved across the included studies. Included studies were generally not well reported, which may hinder replication by clinicians and consolidation of the evidence base by other researchers. Given the substantial burden of cardiovascular disease experienced by those living in rural areas of developed countries, additional high-quality nutrition research that acknowledges the complexities of rural health is required.
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Lee J, Briggs Early K, Kovesdy CP, Lancaster K, Brown N, Steiber AL. The Impact of RDNs on Non-Communicable Diseases: Proceedings from The State of Food and Nutrition Series Forum. J Acad Nutr Diet 2021; 122:166-174. [PMID: 33773948 DOI: 10.1016/j.jand.2021.02.021] [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: 09/18/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
In the United States, nutrition-related morbidities are rising steadily at rates corresponding to increasing overweight and obesity in the population. Such morbidities take huge tolls on personal health and impose high costs on health care systems. In 2019, the Academy of Nutrition and Dietetics (Academy) and the Academy of Nutrition and Dietetics Foundation (Academy Foundation) embarked on a new project titled "The State of Food and Nutrition Series" to demonstrate the value of nutrition interventions led by registered dietitian nutritionists for individuals with the following 3 high-priority non-communicable diseases that affect many in the United States and globally: type 2 diabetes mellitus, chronic kidney disease, and hypertension. Poor nutritional status contributes to disease onset and progression in these non-communicable diseases, and appropriate medical nutrition therapy can prevent or delay worsening and ameliorate poor health outcomes. However, many people who have these conditions do not have access to an registered dietitian nutritionist, and consequently do not receive the nutrition care they need. On February 19-20, 2020 in Arlington, VA, as the first stage in The State of Food and Nutrition Series, the Academy and the Academy Foundation gathered health care policymakers, clinicians, and researchers from across the country for the State of Food and Nutrition Series Forum, where Academy leaders sought input to build a comprehensive research strategy that will quantify the impact of patient access to registered dietitian nutritionist-led nutrition interventions for type 2 diabetes mellitus, chronic kidney disease, and hypertension. This article summarizes the findings of that forum.
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Affiliation(s)
- Jim Lee
- Altarum Fellow, Altarum, Ann Arbor, MI
| | - Kathaleen Briggs Early
- Department of Biomedical Sciences, Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA
| | - Csaba P Kovesdy
- clinical trials program, University of Tennessee Health Science Center, Memphis
| | | | - Nicci Brown
- Academy of Nutrition and Dietetics, Chicago, IL
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Siopis G, Jones A, Allman‐Farinelli M. The dietetic workforce distribution geographic atlas provides insight into the inequitable access for dietetic services for people with type 2 diabetes in Australia. Nutr Diet 2020; 77:121-130. [PMID: 31957210 PMCID: PMC7383994 DOI: 10.1111/1747-0080.12603] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/17/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
AIM Dietetic intervention delivered by Accredited Practising Dietitians is demonstrated to improve clinical outcomes of type 2 diabetes. The aim of the present study was to assess the accessibility to dietetic intervention for people with type 2 diabetes in Australia. METHODS Prevalence data and dietitian workforce distribution data were sourced from Diabetes Australia and Dietitians Association of Australia, respectively. Geographical information system mapping and statistical analysis were used to compare the ratios of dietitians to people with type 2 diabetes across the states of Australia and by index of socio-economic advantage and disadvantage in each state. RESULTS An inequitable distribution of the dietetic workforce and that of the people with type 2 diabetes across Australia was demonstrated. An uneven distribution of the workforce is evidenced across states when compared to the distribution of type 2 diabetes prevalence; with New South Wales having a better ratio than Victoria and South Australia. Maps and prevalence data revealed the dietetic workforce was mostly concentrated in affluent urban centres whereas the type 2 diabetes prevalence rates were higher in rural and remote areas and in areas of lower socio-economic status. CONCLUSIONS This research highlights the need to address the limited access to dietetic intervention for those in rural, remote and disadvantaged areas which also have the greatest need. The financial burden of treating diabetic complications on the national health budget necessitates government initiatives. These should include better use of telehealth dietetic consultations and incentives for dietitians to work in rural, remote and disadvantaged areas.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Alexandra Jones
- School of GeosciencesThe University of SydneySydneyNew South WalesAustralia
| | - Margaret Allman‐Farinelli
- Charles Perkins Centre, School of Life and Environmental SciencesThe University of SydneySydneyNew South WalesAustralia
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