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. For example, Dietetic Assessment is the first step of the DCP (dedication). It is a systematic process to gather dietetically adequate and relevant information about the client by using state-of-the-art methods (central statement). The aim is to identify nature and cause of dietetic related problems of the client (aim and principles). The gathered information are documented in types of categories (client history, diet history, behavioural-environmental, clinical status) or following the ICF-model (operationalization). The clinical cases used within the MOOC proved that the DCP model is suitable to be put into practice. 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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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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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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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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Introductie: De behandeling van Anorexia Nervosa is multidisciplinair. Ondanks de uitvoerige behandeling blijkt dat herstelpercentages laag zijn en terugvalpercentages hoog. Er wordt vaak gezien dat (ex)eetstoornispatiënten een paar jaar na de behandeling nog restrictief eetgedrag vertonen. ‘Intuitief Eten’ is een wetenschappelijk onderbouwde methode die kan helpen met het herstellen van de relatie met eten en leren om weer te vertrouwen op het lichaam. Deze studie is opgezet om uit te zoeken hoe Intuïtief Eten het best geïmplementeerd kan worden in de behandeling van Anorexia Nervosa in de diëtistische praktijk. Methode: Om het (eet)gedrag tijdens en na de eetstoornis en de effecten van Intuïtief Eten bij Anorexia Nervosa in kaart te brengen is literatuuronderzoek uitgevoerd. De literatuur is gezocht in de volgende databases: CataloguePlus, Google Scholar, ScienceDirect en Pubmed. Vervolgens is kwalitatief onderzoek gedaan bij 17 vrouwen, in de leeftijd van 15-35 jaar die in behandeling waren voor Anorexia Nervosa of deze behandeling korter dan 5 jaar geleden hadden afgerond. Ze zijn naar hun meningen en voorkeuren bij de behandeling van Anorexia Nervosa gevraagd, door middel van semigestructureerde diepte-interviews. Resultaten: Uit de resultaten van het literatuuronderzoek is gebleken, dat Intuïtief Eten wordt geassocieerd met positieve behandeluitkomsten bij het herstel van Anorexia Nervosa, maar dat toepassing pas mogelijk is, nadat er een periode van hervoeden door middel van een gestructureerd eetschema heeft plaatsgevonden. Uit de diepte-interviews kwam naar voren dat de volgorde van de principes van belang lijkt voor een succesvolle toepassing van Intuïtief Eten. Het lijkt erop, dat er aan het begin van de behandeling mogelijk een grotere kans is dat er misbruik gemaakt wordt van bepaalde principes van Intuïtief Eten, doordat sommige principes als excuus gebruikt kunnen worden om minder te eten of extra te sporten en daarmee het eetstoornis gedrag voortzetten. Principes gericht op het herkennen van de eetstoornis, het lichaamsbeeld en omgaan met emoties, kunnen mogelijk al in een eerder stadium van de behandeling worden toegepast. De principes gericht op het luisteren naar honger- en verzadigingssignalen, bewegen en gezonde voeding worden door respondenten gezien als valkuilen en kunnen daardoor wellicht pas later toegepast worden. Conclusie: Om de toepassing van Intuïtief Eten bij Anorexia Nervosa succesvol te laten verlopen lijkt het van belang om rekening te houden met de volgorde waarin de principes worden geïntroduceerd. Rekening houden met de fase waarin bepaalde principes toegepast kunnen worden, kan mogelijk het verschil maken voor een succesvolle behandeling en zou de kans kunnen verkleinen dat de patiënt misbruik maakt van de principes. Het stroomschema: “Implementatie van Intuïtief Eten bij het herstel van Anorexia Nervosa” kan worden ingezet als hulpmiddel bij het toepassen van Intuïtief Eten bij patiënten met Anorexia Nervosa. Introduction: Anorexia Nervosa treatment is multidisciplinary. Despite comprehensive treatment, recovery rates are found to be low and relapse rates high. It is often seen that (former) eating disorder patients still exhibit restrictive eating behaviour a few years after treatment. 'Intuitive Eating' Wetenschap | Origineel artikel26 Voeding & Visie jaargang 36, nummer 1 2023 is a science-based method that can help restore the relationship with food and learn to trust the body again. This study was designed to find out how Intuitive Eating can best be implemented in the treatment of Anorexia Nervosa in dietetic practice. Method: To identify the (eating) behavior during and after the eating disorder and the effects of Intuitive Eating in Anorexia Nervosa, a literature search was conducted. The literature was searched in the following databases: CataloguePlus, Google Scholar, ScienceDirect and Pubmed. Next, qualitative research was conducted among 17 women, aged 15-35 years who were being treated for Anorexia Nervosa or who have completed this treatment less than 5 years ago. They were asked about their opinions and preferences in the treatment of Anorexia Nervosa, through semi-structured in-depth interviews. Results: The results of the literature review revealed that Intuitive Eating is associated with positive treatment outcomes in the recovery from Anorexia Nervosa, but that application is only possible after a period of refeeding through a structured eating schedule has taken place. The in-depth interviews revealed that the order of the principles appears to be important for the successful application of Intuitive Eating. There seems to be a greater chance of misusing certain principles of Intuitive Eating at the beginning of treatment, as some principles might be used as an excuse to eat less or exercise extra, thus continuing the eating disorder behavior. Principles focused on recognizing the eating disorder, body image and dealing with emotions can possibly be applied early in treatment. Principles focused on listening to hunger and satiety signals, exercise and healthy eating are seen as pitfalls and can possibly only be applied later. Conclusion: In order for the application of Intuitive Eating in Anorexia Nervosa to be successful, it seems important to take into account the order in which the principles are introduced. Considering the phase in which certain principles can be applied might make the difference to successful treatment and possibly reduces the likelihood of the patient misusing the principles. The flowchart: "Implementing Intuitive Eating in Recovery from Anorexia Nervosa" can be used as an aid in applying Intuitive Eating to patients with Anorexia Nervosa.
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Fysieke activiteit wordt vaak gezien als een belangrijke manier om overgewicht onder kinderen tegen te gaan. Regelmatig wordt daarbij ook het bewegingsonderwijs een rol toegedicht. Elke dag gylmles zou een van de manieren zijn om overgewicht te verminderen of te voorkomen bij kinderen. Maar heeft fysieke activiteit wel zo veel invloed? En zo ja, biedt de gymles dan de juiste vorm van activiteit? Of is gymles misschien in staat om het bewegingsgedrag buiten de lessen gezonder te maken?
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Aim: The prevalence of age‐related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. Methods: In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using ‘dietitian’, ‘elderly’ and ‘malnutrition’ as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. Results: Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. Conclusions: The role of dietitians in managing age‐related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate. https://doi.org/10.1111/1747-0080.12546 LinkedIn: https://www.linkedin.com/in/matthijs-fleurke-66279110/ https://www.linkedin.com/in/dorien-voskuil-9b27b115/
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To examine the association of adolescents' snack and soft drink consumption with friendship group snack and soft drink consumption, availability of snacks and soft drinks at school, and personal characteristics, snack and soft drink consumption was assessed in 749 adolescents (398 girls, 351 boys, age 12.4 - 17.6 years), and their friends, and snack and soft drink availability at schools was measured. In regression analysis, consumption by friends, snack and soft drink availability within school, and personal characteristics (age, gender, education level, body mass index) were examined as determinants of snack and drink consumption. Snack and soft drink consumption was higher in boys, soft drink consumption was higher in lower educated adolescents, and snack consumption was higher in adolescents with a lower body weight. Peer group snack and soft drink consumption were associated with individual intake, particularly when availability in the canteen and vending machines was high. The association between individual and peer snack consumption was strong in boys, adolescents with a lower education level, and adolescents with lower body weights. Our study shows that individual snack and soft drink consumption is associated with specific combinations of consumption by peers, availability at school, and personal characteristics.
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Objective: This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8–12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. Results: Analysis of covariance showed a significant intervention effect on BMO SDS in favour of the intervention group (b-coefficient - 0.13 ± 0.03; p < 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p=0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.
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