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PubMed1996

Fellow of the American Dietetic Association credentialing program: development and implementation of a portfolio-based assessment.

This report has described the measurement and operational procedures used for the design, development, and implementation of the newly inaugurated Fellow of The American Dietetic Association credentialing program. The program was established to identify and certify registered dietitians who possess the characteristics of advanced-level practice. The main features of the Fellow program are as follows. It is based on the results of an empirical study that identified the characteristics of advanced-level practice. It is guided by the Fellow Assessment Plan, which specifies the content and level of dietetics practice involved and the psychometric and operational requirements for sound measurement. It is a performance-based portfolio assessment of six professional characteristics (education, work experience, professional achievement, professional roles, professional contacts, and approach to practice). It uses objective automated computer scoring and independent peer-review grading of candidate materials in relation to an explicit scoring rubric. It requires statistical analysis of the database of candidate scores, which is conducted to ensure that the scoring of candidate materials is accurate and reliable and that the assessment, as a measurement instrument, is psychometrically sound. It involves a standard-setting workshop in which a panel of subject-matter experts establish the lowest level of acceptable candidate performance on Approach to Practice; the passing standard for the other five characteristics was preestablished by the empirical study. A careful review of all evidence on the development and implementation of the 1994 Fellow assessment suggests that these procedures are technically sound and produce psychometrically defensible results. Our evaluation and commentary from CDR and CTB staff, subject-matter expert participants, and the candidates themselves suggested a number of ways to improve the Fellow program in subsequent administrations of the assessment. Changes have been implemented and CDR will continue to consider all data in its ongoing improvement efforts.

Credentialing↗

PubMed1996

Perspectives on history: army dietetics in southwest Asia during Operation Desert Shield/Desert Storm.

The Army dietitians deployed during Operation Desert Shield and Operation Desert Storm exemplified the commitment, dedication, patriotism, and professionalism of their predecessors. Although some were continuously on the move and all dealt with the extremes of a desert environment, were frequently handicapped with equipment shortages, and coped constantly with the monotony of limited ration variety, throughout their experiences these professionals expressed pride in participating in this national undertaking. The purposes of this article are to familiarize members of The American Dietetic Association with the responses of their colleagues in the US military to another of their nation's calls, to relate some aspects of Army dietetics experienced in Southwest Asia, and to identify the lessons learned in that engagement.

Dietetics↗

PubMed1996

Position of the American Dietetic Association: nutrition education for the public.

In keeping with the ADA's mission, which is to be "the advocate of the dietetics professional serving the public through the promotion of optimal nutrition, health and well-being," ADA supports nutrition education delivered by qualified dietetics professionals as essential for the public to achieve and maintain optimal nutritional health. Nutrition education serves as a foundation for achieving notable advances in the nutritional status of the public. To be effective in creating actual behavior change, nutrition education programs must be developed on the basis of the needs, behaviors, motivations, and desires of target audiences. A wide variety of strategies have been identified as effective in helping to increase awareness, enhance motivation, and foster and sustain behavior change. A multiple reinforcing strategy, by which consumers are repeatedly reached with consistent messages, may support individual nutrition education efforts best. It is clear that more research is necessary to identify the needs, behaviors, motivations, and desires of target audiences. Developing and testing cost-effective methods for evaluating the effectiveness of nutrition education programs along with comparative models to investigate the effectiveness of alternative educational interventions are also needed. Practitioner involvement in nutrition education research is vital to gain maximum benefit.

Dietetics↗

PubMed1997

Research competencies in the dietetics curricula.

Investment in dietetics research has the potential to improve general health; increase work performance and learning capacity; extend disease-free life; reduce birth defects, infections, and chronic diseases; and decrease health care costs. Opportunities exist for research in the areas of solid waste management, global environment, health care reform, and foodservice systems management. Research efforts can focus on cost-effectiveness and medical efficacy of dietary services to improve third-party reimbursement. Educators have a stake in creating the future by conducting research, teaching research to dietetic students, and investigating the effectiveness of education.

Clinical Competence↗

PubMed1998

Position of the American Dietetic Association: liberalized diets for older adults in long-term care.

Malnutrition, weight loss, and resident satisfaction are serious issues that need to be addressed by dietetics professionals working in long-term-care facilities. Medical nutrition therapy for older adults in long-term care is multifaceted and critical to reducing the risks of malnutrition and weight loss. To meet the needs of every resident, dietetics professionals must consider each person holistically, including personal goals, overall prognoses, benefits and risks of treatment, and perhaps most important, quality of life. For some long-term-care residents the use of liberalized diets, when appropriate, can enhance both quality of life and nutritional status, thus increasing the resident's satisfaction with the meals provided and reducing the risks of malnutrition and weight loss.

Aged↗

PubMed1999

Position of the American Dietetic Association: medical nutrition therapy and pharmacotherapy.

It is the position of The American Dietetic Association that medical nutrition therapy and lifestyle counseling are integral components of medical treatment for the management of selected conditions for which pharmacotherapy is indicated. The Association promotes a team approach to care for clients receiving pharmacotherapy and encourages active collaboration among dietetics professionals and other members of the health care team. Numerous chronic medical conditions respond to medical nutrition therapy; however, pharmacotherapy may be needed to achieve control. In some cases, medical nutrition therapy and pharmacotherapy may need to be initiated simultaneously. Medical nutrition therapy is critical to the management of a variety of chronic diseases, is effective in managing disease, and is cost-effective. The use of a coordinated multidisciplinary team effort is critical to the success of medical nutrition therapy and pharmacotherapy. Because medical nutrition therapy with pharmacotherapy is a treatment of long duration that requires monitoring of compliance and effectiveness, it is best accomplished through a team approach.

Chronic Disease↗

PubMed1999

Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition.

Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.

Canada↗

PubMed1999

Broadening career opportunities in dietetics: employment in independent research.

Independent research organizations provide opportunities for dietetics professionals, along with the interdisciplinary research team, to make an optimal contribution to health care. They also offer a wide variety of career options from principal investigators to study managers. Further, opportunities in progressive independent research organizations often focus on linking research and practical nutritional applications to enhance the dietetics profession. With the shrinking traditional employment market for dietitians, new options must be pursued. Dietitians should consider independent research organizations for an exciting and rewarding career opportunity.

Career Choice↗

PubMed1999

Using standardized patients to train and evaluate dietetics students.

Faced with a dwindling number of clinical sites for training dietetics students, we incorporated a standardized patient scenario of a 17-year-old pregnant woman into a nutrition counseling course. A young woman was hired to be the patient and was trained extensively. Each student signed up for a 20-minute block of time to assess her and provide nutrition instruction, after which the standardized patient and course instructor provided individualized feedback to each student. Students then completed a brief questionnaire related to the standardized patient session. Overall, student response to the standardized patient session was positive, and students believed standardized patients should be included formally in undergraduate training. The students noted that the standardized patient session allowed them to be trained and evaluated objectively. Because of their ease in building rapport with the standardized patient, students reported that they were able to provide more in-depth education. They also appreciated the immediate and detailed performance review provided by the standardized patient and the instructor. We conclude that standardized patient sessions provide a great service to dietetics students, and plans to develop another standardized patient scenario that students can follow up throughout the continuum of care are underway.

Adolescent↗

PubMed1999

Position of the American Dietetic Association: functional foods.

It is the position of The American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to further define the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, both from phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronurtrient and micronutrient intake. Analyzing the content, of other physiologically active components will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.

Dietetics↗

PubMedDate not supplied

Advanced dietetic training in nutrition support and metabolism: the University of Pennsylvania Medical Center experience.

The dietetic fellowship at the University of Pennsylvania Medical Center is highly rewarding for the nutrition support dietitians, and the dietetic fellows have identified an increased self-confidence as one of the major benefits. Advanced training of this nature is very labor intensive. In the current environment of cost containment and down-sizing of staff, it is unlikely that this type of program will flourish due to the high labor cost involved and limited funding available.

Academic Medical Centers↗

PubMed2001

Survey of UK dietetic departments: diet in secondary prevention of myocardial infarction.

AIM: To collate information on current British dietetic practice in the area of diet in secondary prevention of myocardial infarction, and to compare this with best evidence. METHODS: A questionnaire was sent to all Chief Dietitians, to be completed by the whole department, asking about current dietary advice and practice, referrals and written dietary information for people following myocardial infarction. RESULTS: Fifty-seven per cent of questionnaires were returned. Dietary fat advice was prioritized by 84% of departments, fruit and vegetables by 49%, oily fish by 45% and fibre by 28%. Most dietitians (81%) felt that this advice would protect from further cardiovascular disease. Percentages of post-myocardial infarction patients given advice by a dietitian varied (median 60%), reasons for non-referral included patients having normal lipids or weight. More were given dietary advice by another health professional (median 90%); however, most dietitians were unsure about the quality of this advice. Diet sheets were felt to reflect advice priorities, but where sheets were sent they were much less likely than departments to prioritize oily fish or fruit and vegetable advice. CONCLUSION: Dietetic practice for people following myocardial infarction is out of line with current best evidence. Almost half of departments correctly prioritize oily fish advice, but often only see patients with raised lipids or weight. This is not the most effective strategy for preventing deaths.

Diet↗

PubMed1999

The application of the continuum of care model in the re-configuration of nutrition and dietetics services.

The continuum of health care model can be used to improve service delivery. Within a hospital setting, finite resources are available. Service gaps must be identified, priorities established and resources re-distributed to meet these gaps. Using Continuous Quality Improvement (CQI) tools, barriers to change were identified and a plan for improvement was formulated. Areas receiving disproportionate resources were identified and a more even resource allocation adopted. In an illustration of the success of strategic change, core services were not only maintained but also showed improved efficiency. The Department of Nutrition and Dietetics at Wollongong and Port Kembla Hospitals achieved an increase in dietetic services through a reorientation of current resources.

Continuity of Patient Care↗

PubMed2005

The rise and fall of dietetics and of nutrition science, 4000 BCE-2000 CE.

OBJECTIVE: To outline the history of dietetics since its beginnings in recorded history, and of nutrition science in its first phase beginning in the mid-nineteenth century and then its second phase in the second half of the twentieth century. METHOD: Three narrative overviews: of dietetics from its beginnings until after the end of the medieval and then Renaissance periods in Europe; of nutrition science in its first phase from its beginnings in the mid-nineteenth century until the middle of the twentieth century, with reasons for its rise; and of nutrition science in its second phase in the second half of the twentieth century, with reasons for its decline. CONCLUSIONS: In its third phase in the twenty-first century, the new nutrition science should regain much of the vision and scope of its preceding disciplines.

Dietetics↗

PubMed2004

Using interpretative phenomenological analysis for public health nutrition and dietetic research: a practical guide.

The present paper introduces interpretative phenomenological analysis (IPA) as a framework for analysing qualitative research data collected for public health nutrition and dietetic research studies. The theoretical roots of IPA have been set out briefly in order to help researchers decide whether the approach is relevant for them and their particular research questions. IPA can be used to analyse data from one-to-one interviews in order to develop 'thick descriptions' that may help illuminate human experience. IPA can also be used to develop theories and/or models, which could help inform policy. The main body of the paper describes the analytical techniques and procedures used to achieve both outcomes in a practical way, using examples from the author's own research. In the following paper Krueger's methods for analysing focus group data are set out for comparison. It is hoped that these papers will empower researchers with little experience of qualitative research to develop confidence with qualitative data analysis. In addition, it is hoped that the material will stimulate debate amongst more experienced qualitative researchers from a public health or dietetic background.

Data Interpretation, Statistical↗

PubMed2005

Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward.

OBJECTIVE: To examine how improved attention to nutritional status and dietary intake, achieved through the employment of dietetic assistants (DAs), will affect postoperative clinical outcome among elderly women with hip fracture. DESIGN: Open prospective randomised controlled trial, comparing conventional nursing care with the additional nutritional support provided by DA. SETTING: Thirty-eight bedded acute trauma ward in a teaching hospital. PARTICIPANTS: All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached. Three hundred and eighteen (93%) agreed to inclusion. Sixteen were ineligible as they were immediately transferred to another acute ward, were managed conservatively or died preoperatively. PRIMARY OUTCOME MEASURE: Postoperative mortality in the acute trauma unit. SECONDARY OUTCOME MEASURES: Postoperative mortality at 4 months after fracture, length of stay, energy intake and nutritional status. RESULTS: DA-supported participants were less likely to die in the acute ward (4.1 versus 10.1%, P = 0.048). This effect was still apparent at 4 month follow-up (13.1 versus 22.9%, P = 0.036). DA-supported subjects had significantly better mean daily energy intake (1,105 kcal versus 756 kcal/24 h, 95% CI 259-440 kcal/24 h, P<0.001), significantly smaller reduction in mid-arm circumference during their inpatient stay (0.39 cm, P = 0.002) and nonsignificantly favourable results for other anthropometric and laboratory measurements. CONCLUSION: Dietetic or nutrition assistants are being introduced in units across the UK. This, the largest ever study of nutritional support after hip fracture, shows that their employment significantly reduced patients' risk of dying in the acute trauma unit; an effect that persisted at 4 month follow-up.

Aged↗

PubMed2004

Choosing to practice in rural dietetics: what factors influence that decision?

OBJECTIVE: The present study aimed to identify those factors that influence the decision of a dietitian to consider working in a rural area. DESIGN: A qualitative design using focus groups was chosen for this study to allow for in-depth data to be obtained. SETTING: University of Newcastle, Callaghan Campus. SUBJECTS: Twenty-three students/new graduates from the Bachelor of Health Science (Nutrition and Dietetics) degree at the University of Newcastle. MAIN OUTCOME MEASURES: Not applicable, this project was an exploratory study. RESULTS: A number of factors that influence the decision of dietetic students and newly graduated dietitians to consider working in a rural area were identified. These fell into the following main thematic areas: job prospects; rural lifestyle; comfort zones; support networks; promotion opportunities/professional development; type of work/work role; rural needs; and time frame. CONCLUSIONS: The present study found that choosing a location to work (whether it be a rural one or not) is a complex process and involves a number of interacting factors. Also those factors that may influence one dietitian to choose a career in a rural area may also be the factors that influence another dietitian not to choose a career in a rural area.

Attitude of Health Personnel↗

PubMed2003

Trusting George Cheyne: scientific expertise, common sense, and moral authority in early eighteenth-century dietetic medicine.

Whenever physicians give directions to patients there is always a question of their authority to do so: what is it that they know, and who is it that they are, that gives them this authority? The problem is fully general, but it takes especially interesting forms in early modern dietetics, where patients were reckoned to possess much pertinent and reliable knowledge, and where medical dietetics occupied terrain already densely occupied by moral prudence. This article addresses these issues in relation to the writings and practice of George Cheyne (1671-1743), iatromechanist, dietary writer, and fashionable physician. Special attention is given to the relation between Cheyne's scientific expertise and the texture of the advice he gave to two patients, the printer and novelist Samuel Richardson and Selina, countess of Huntingdon.

Authoritarianism↗