Using a Dietetic Care Process (DCP) can lead to improved application of evidence-based guidelines and critical thinking in dietetics. One aim of the project Improvement of Education and Competences in Dietetics (IMPECD) is to develop a unified DCP for international educational purposes. Therefore, a comparison of European DCPs was needed.A concise literature search and semi-structured interviews with experts representing the full EFAD (European Federation of the Associations of Dietitians) member states were conducted from June to October 2017.16 out of 23 EFAD member states responded (70%) from which 13 indicated to use a DCP. Eight different DCPs were found, with four to six core steps and three graphical representations. In one country the use of a dietetic process is indicated by law. The DCPs have more similarities than differences as they follow the same principles. Differences in language or form may not limit the improvement in collaboration and international exchange in dietetic practice. These results provide a good basis for the development of a unified DCP for educational purposes.
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Introduction: Different models of frameworks for dietetic care are used in Europe. There is a substantial need for a consistent framework to compare research results and to cooperate on an international level. Therefore, one of the goals of the EU-funded project IMPECD was the development of a unified framework Dietetic Care Process (DCP) in order to foster a shared understanding of process-driven dietetic counselling. Materials and Methods:: Based on a literature review and in-depth analysis of different frameworks an iterative and incremental development process of finding solutions for decision-making within the consortium consisting of dietetic experts from 5 European HEI was passed. The developed DCP model was integrated in an online training course including 9 clinical cases (MOOC) to train students. The draft versions and the concluding final version DCP model were evaluated and re-evaluated by teachers and 25 students at two Intensive Study Programmes. Results:: The DCP model consists of five distinct, interrelated steps which the consortium agreed on: Dietetic Assessment, Dietetic Diagnosis, Planning Dietetic Intervention, Implementing Dietetic Intervention, Dietetic Outcome Evaluation. A standardized scheme was developed to define the process steps: dedication, central statement, aim and principles, and operationalization. Discussion:: Existing different process models were analyzed to create a new and consistent concept of a unified framework DCP. The variety within the European countries represented by the consortium proved to be both a challenge in decision-making and an opportunity to integrate multinational perspectives and intensify the scientific discourse. The development of a standardized scheme with precise definitions is a prerequisite for planning study designs in health services research. Besides, clarification is essential for establishing process-guided work in practice. The evaluated MOOC is now implemented in study programmes used by 5 European HEI in order to keep approaches and process-driven action comparable. The MOOC promotes the exchange of ideas between future professionals on an international level.
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BACKGROUND & AIMS: Dietetic interventions contribute to certain health objectives and other outcomes, but are mostly part of a multimodal and multidisciplinary approach what makes evaluating the actual effects of dietitians' involvement rather complex. Although monitoring and outcome evaluation (M&OE) can provide routine data to prove the effectiveness of dietetic interventions, this has not been established yet in different dietetic settings.METHODS: A comprehensive framework for M&OE in dietetics was developed by dietetic experts from five European higher education institutes for dietetics in the course of the EU sponsored project "Improvement of Education and Competences in Dietetics (IMPECD)".RESULTS: Firstly, clear definitions on M&OE are proposed to facilitate the use of consistent terminology, with a specific emphasis on the term "impact" covering macro-level outcomes such as cost-effectiveness. Secondly, the Dietetic Care Process (DCP) was merged into a logic model to demonstrate the position of M&OE in relation to intervention planning and implementation, in both group and individual settings. Thirdly, selecting the appropriate indicators is indispensable to monitor and evaluate outcomes, and requires a high level of dietitians' critical reasoning. A categorized overview of indicators is provided to support this process. Lastly, the consortium developed a checklist to give dietitians a handle on what elements could be included in their M&OE plan and trigger them to perform M&OE in practice.CONCLUSIONS: Innovative M&OE models may help dietitians to demonstrate their effectiveness in improving clinical outcomes and justify their role in health care.
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RATIONALE: Current developments drive dieticians in the primary care setting to demonstrate their effectiveness to both patients and stakeholders. Working with SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goal setting may increase effectiveness. This study describes the current dietetic practice in the primary care setting in The Netherlands with regard to goal setting.
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Background: Although diagnosing and treating malnutrition, sarcopenia and underweight are recommended to be embedded and sustained within nutritional care, it is unknown if that is facilitated in geriatric rehabilitation. This study determined the proportion of geriatric rehabilitation inpatients with malnutrition, sarcopenia or underweight receiving dietetic interventions as part of routine clinical care and if these patients have greater improvements in body weight and composition compared to patients not receiving dietetic interventions.Methods: Geriatric rehabilitation inpatients from the observational REStORing health of acutely unwell adulTs (RESORT) cohort were included (n=971, median age 83.2 [77.7-88.8] years, 58.5% (n=568) females). Malnutrition, sarcopenia and underweight were defined by the Global Leadership Initiative of Malnutrition, European Working Group on Sarcopenia in Older People 2 and age-specific body mass index cut-offs. Data on dietetic interventions initiated by dietitians as part of clinical care was extracted from the centralised hospital database. Changes in body weight (kg), skeletal muscle mass (kg, %), and fat mass (kg, %) from admission to discharge were determined using linear mixed models.Results: Dietetic interventions were received by 306 (62.0%), 138 (71.5%) and 153 (76.9%) of patients with malnutrition (n=493), sarcopenia (n=193) and underweight (n=199). Duration and frequency of dietetic interventions were higher in patients with malnutrition, sarcopenia or underweight compared to patients without those conditions. There were no differences in body weight/composition changes in patients with malnutrition, sarcopenia or underweight receiving dietetic interventions compared to those not receiving interventions.Conclusions: One-third of geriatric rehabilitation inpatients with malnutrition, sarcopenia or underweight are not receiving dietetic interventions and therefore the referral and diagnostic process require improvements. Patients with malnutrition, sarcopenia or underweight receiving dietetic interventions had no greater improvements in body weight/composition compared to those who did not receive interventions. Tailoring dietetic interventions for malnutrition, sarcopenia and underweight diagnosis may improve patient outcomes.
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BACKGROUND & AIMS: Although up-to-date definitions for nutrition assessment integrate behavioural components, it is not clear what behavioural components are to be assessed. Since behavioural modification is linked to effective therapeutic dietetic interventions, assessing behaviour and factors influencing behaviour might be beneficial to improve personalized dietetic outcome. The aim of the following report is to emphasize the role of behavioural components and factors affecting behaviour at baseline nutrition assessment in personalized dietetic intervention.METHODS: The present work is part of the EU-funded project IMPECD ("Improvement of Education and Competences in Dietetics", www.impecd.eu). The project aims to improve the clarity and consistency of national dietetic process models to unify education and training of future dietitians. Experts from five European Universities of Applied Sciences (UAS) in Antwerp (BE), Fulda (DE), Groningen (NL), Neubrandenburg (DE) and St. Pölten (AT) developed a Massive Open Online Course (MOOC) consisting of several clinical cases. It warranted a detailed evaluation of all dietetic care process steps, starting with nutrition assessment.RESULTS: Results for motivation assessed during nutrition assessment are not consistently positively associated with outcome and the added value of assessing them at baseline is still unclear. However, depressive symptoms, emotional distress, and anxiety negatively affect eating and physical activity and therefore limit the efficacy of the dietetic intervention. Assessing behavioural components including nutrition literacy is an important precondition for influence on behavioural modification.CONCLUSION: Indisputably, baseline assessment of behavioural components and factors influencing behaviour are important to increase the therapeutic efficacy of personalized dietetic interventions.
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Malnutrition is an alarming and ongoing healthcare problem globally. Malnutrition has a negative impact on the individual patient, leading to poorer clinical outcomes and increased mortality, but also poses an economic burden on society. Proper identification and diagnostics are prerequisites for initiation of treatment. In 2019, the Global Leadership Initiative on Malnutrition, a consensus-based global framework to uniformly diagnose malnutrition across populations, healthcare settings, and countries was published. Identifying and treating malnutrition is an interdisciplinary team effort. Nonetheless, the nutrition and dietetics profession is specifically trained for diagnosing and treating nutrition(-related) conditions, and therefore has a key role in the interdisciplinary team in implementing the GLIM framework in clinical practice. For the nutrition and dietetics profession, GLIM offers a great opportunity for moving both the scientific and clinical knowledge of malnutrition management forward. While the GLIM framework has been extensively studied since its launch, various knowledge gaps still remain. For the nutrition and dietetics profession, these knowledge gaps mainly relate to the GLIM implementation process, to the role of GLIM in relation to the nutrition care process, and to treatment strategies for various nutrition-related conditions. In this opinion paper, we aimed to describe the rationale for implementing the GLIM framework in clinical dietetic practice, and propose a research agenda based on knowledge gaps regarding GLIM in relation to nutrition care from a dietetic point of view.
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Malnutrition is a serious and widespread health problem in community-dwelling older adults who receive care in hospital and at home. Hospital and home care nurses and nursing assistants have a key role in the delivery of high-quality multidisciplinary nutritional care. Nursing nutritional care in current practice, however, is still suboptimal, which impacts its quality and continuity. There appear to be at least two reasons for this. First, there is a lack of evidence for nutritional care interventions to be carried out by nurses. Second, there are several factors, that influence nurses’ and nursing assistants’ current behaviour, such as lack of knowledge, moderate awareness of the importance and neutral attitudes. This results in a lack of attention towards nutritional care. Therefore, there is a need to generate more evidence and to focus on targeting the factors that influence nurses’ and nursing assistants’ current behaviour to eventually promote behaviour change. To increase the likelihood of successfully changing their behaviour, an evidence-based educational intervention is appropriate. This might lead to enhancing nutritional care and positively impact nutritional status, health and well-being of community-dwelling older adults. The general objectives of this thesis are: 1) To understand the current state of evidence regarding nutrition-related interventions and factors that influence current behaviour in nutritional care for older adults provided by hospital and home care nurses and nursing assistants to prevent and treat malnutrition. 2) To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults and to describe the intervention development and feasibility.
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Physiotherapy, Dietetics and Occupational Therapy have been collaborating over recent years to develop an optimal healthcare programme for patients with Post Intensive Care Syndrome (PICS). This case is an example of PICS symptomatology and focuses on the collaboration between Physiotherapy and Dietetics. What is PICS? Owing to healthcare improvements, more and more patients are surviving the intensive Care Unit (ICU), and recovery during and after ICU stay has been receiving more attention [1, 2]. Approximately 30% of the patients admitted to an ICU have persistent symptoms including muscle weakness, reduced walking ability, fatigue, concentration deficits, memory problems, malnutrition, sleep and mood disorders sometimes even years after discharge [3-8]. Since 2012, this combination of physical, cognitive and psychiatric manifestations and reduced quality of life after staying in an ICU has been recognised as Post Intensive Care Syndrome (PICS) [9]. The impact of PICS is often not limited to the patient as it may also impact the mental status of the patient’s immediate family. This is known as PICS-Family (PICS-F) [10-12]. Treatment of PICS: Approximately 80% of PICS patients need primary care physiotherapy. Physiotherapists and GPs are often the only primary care professionals involved in the recovery process of these patients after hospital discharge [13, 14]. Both patients and healthcare professionals report a number of difficulties, e.g. limited transmural continuity in healthcare, coordination of multidisciplinary activities, supportive treatment guidelines and specific knowledge of pathology, treatment and prognosis. Patients report that they are not adequately supported when resuming their professional activities and that medical and allied healthcare treatments do not fully meet their needs at that time [15-18]. The REACH project: In order to improve the situation, the REACH project (REhabilitation After Critical illness and Hospital discharge) was started in Amsterdam region in the Netherlands. Within REACH, a Community of Practice – consisting of professionals (physiotherapists, occupational therapists, dieticians), those who live or have lived with the condition and researchers – has developed a transmural rehab programme. A special attribute of this programme is the integration of the concept of “positive health”. The case in this article describes the treatment of a PICS patient treated within the REACH network.
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