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At least 19 recordsLinked to original sources
PubMed2001

Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol.

BACKGROUND: The average level of blood cholesterol is an important determinant of the risk of coronary heart disease. Blood cholesterol can be reduced by dietary means. Although dietitians are trained to provide dietary advice, for practical reasons it is also given by other health professionals and occasionally through the use of self-help resources. OBJECTIVES: To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 2 1999), MEDLINE (1966 to January 1999), EMBASE (1980 to December 1998), Cinahl (1982 to December 1998), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field. SELECTION CRITERIA: Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources. The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Eleven studies with 12 comparisons were included, involving 704 people receiving advice from dietitians, 486 from other health professionals and 551 people using self-help leaflets. Four studies compared dietitian with doctor, seven with self-help resources, and one compared dietitian with nurse. Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)). There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)). No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian groups showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)). No significant heterogeneity between the studies was detected. REVIEWER'S CONCLUSIONS: Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials. More evidence is required to assess whether change can be maintained in the longer term. There was no evidence that dietitians provided better outcomes than nurses.

Cholesterol↗
PubMed1997

The role of nutrition support dietitians as viewed by chief clinical and nutrition support dietitians: implications for training.

OBJECTIVES: To determine current and ideal frequencies with which nutrition support dietitians perform each item on a list of 15 tasks and evaluate dietitian preparation for the practice of nutrition support. DESIGN: Data were collected using two questionnaires, one completed by the chief clinical dietitian and the other completed by the nutrition support dietitian at each hospital surveyed. Both versions of the questionnaires contained a list of 15 tasks that had been validated as being related to advanced nutrition support by a panel of 20 nutrition support experts using a modified Delphi method. Follow-up telephone calls were made to increase the number of responses. SAMPLE: Questionnaires were mailed to the chief clinical dietitian at 300 randomly selected, general medical/surgical hospitals with 300 or more beds in the United States and Puerto Rico. A total of 134 chief clinical dietitians (45%) and 129 nutrition support dietitians (43%) responded to the surveys; 124 (41%) and 120 (40%) questionnaires, respectively, were usable for statistical analyses. STATISTICAL ANALYSES: The Wilcoxon matched-pairs signed-ranks test was used to determine differences between nutrition support dietitian actual and ideal frequencies and between chief clinical dietitian actual and ideal frequencies for each of the 15 tasks. The Mann-Whitney U-Wilcoxon rank sum W test was used to determine differences between nutrition support dietitian and chief clinical dietitian actual frequencies and between nutrition support dietitian and chief clinical dietitian ideal frequencies for each of the 15 tasks. Descriptive statistics were used to analyze the questions regarding educational preparation for nutrition support practice and demographic data. RESULTS: The ideal frequency for each of the 15 tasks was significantly greater (P < .0001) than the actual frequency reported by nutrition support dietitians and chief clinical dietitians. Whereas chief clinical dietitians and nutrition support dietitians agreed on the ideal frequency for most tasks, the nutrition support dietitian ideal frequency indicated for the tasks "determines macronutrient composition of parenteral nutrition" and "performs physical examinations related to nutritional status, fluid status, and gastrointestinal function" was significantly greater (P < .001, P < .05), respectively) than the ideal frequency indicated by chief clinical dietitians. Of the nutrition support dietitians, 79% agreed and 16% somewhat agreed that experiences beyond those required for becoming a registered dietitian are needed to provide nutrition support dietitians with specialized clinical skills. APPLICATIONS/CONCLUSIONS: Nutrition support dietitians desire increased responsibility for delivering nutrition support to their patients and this desire is largely supported by chief clinical dietitians. Nutrition support dietitians appear to have a strong interest in postregistration qualifying experiences that would provide a foundation for expanding their roles. According to the results of this study, programs designed to provide practical, clinical experience in nutrition support are needed.

Attitude of Health Personnel↗
PubMed2002

Energy intake and energy expenditure: a controlled study comparing dietitians and non-dietitians.

BACKGROUND: Underreporting of food intake has been commonly observed. We hypothesized that experience with recording dietary information might increase the accuracy of the records. To test this hypothesis, we compared energy intake and energy expenditure in dietitians-who are experienced in recording food intake-with those of non-dietitians, whose only exposure to training to record food was in the context of this trial. SUBJECTS/SETTING: Subjects for this study were 10 female registered dietitians and 10 women of comparable age and weight who were not dietitians. DESIGN: This study compared the energy intake obtained from 7-day food records with energy expenditure measured over the corresponding 7-day period using doubly labeled water. STATISTICAL ANALYSIS: Data were compared by an analysis of variance METHODS: All subjects were trained to provide a 7-day weighed food intake record. Energy expenditure was measured with doubly labeled water over the 7 days when the weighed food intake record was obtained. A total of 10 dietitians and a control of group of 10 women of similar age and weight were recruited for this study. Participants were told that the goal was to record food intake as accurately as possible, because it would be compared with the simultaneous measurement of energy expenditure determined by doubly labeled water. RESULTS: The energy expenditure of the dietitians and controls were not different (2,154+/-105 [mean+/- standard error of the mean] kcal/day for dietitians and 2,315 +/- 90 kcal/ day for controls). The dietitians underreported their energy intake obtained from the food records by an average of 223 +/- 116 kcal/day, which was not different from their energy expenditure. Participants in the control group, as hypothesized, significantly underreported their energy intake (429 +/- 142 kcal/day, P < .05). CONCLUSION: Dietitians estimated their energy intake more accurately than non-dietitians, suggesting that familiarity with and interest in keeping food records may lead to more reliable estimates of energy intake.

Adult↗
PubMed1997

Nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians.

OBJECTIVE: To document and compare nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians. DESIGN: Subjects completed a mailed survey. Respondents provided demographic information and used a 5-point Likert scale to note whether each of 14 job functions was appropriate for general clinical dietitians, renal dietitians, or both. SUBJECTS: Five hundred forty-one physicians registered with the Ohio State Medical Board (OSMB) were surveyed. Within this group were 283 nephrologists (the population of nephrologists registered with the OSMB) and 258 internal medicine physicians (selected randomly by the OSMB). A total of 133 physicians (25%) returned the survey; 119 surveys were usable: 70 from nephrologists and 49 from internists. STATISTICAL ANALYSES PERFORMED: A composite variable was created by coding and summing physicians' responses regarding dietitian job functions. This variable was averaged for both physician categories. A t test was conducted to compare composite variable results between the two physician groups. RESULTS: At least 50% of nephrologists and internists agreed that both types of dietitians should conduct nutrition assessments, determine patients' energy needs, evaluate medication-nutrient interactions, recommend diet and tube-feeding orders, instruct patients about physician-ordered diets, and teach nutrition concepts to hospital interns. Few physicians agreed that either type of dietitian should order diets, tube feedings, or diet instructions. APPLICATIONS/CONCLUSIONS: Clinical dietitians can educate physicians about dietitians roles informally in their institutions and formally by supporting programs like The American Dietetic Association Physician Nutrition Education Program. In addition, dietetics educators can hone their students' communication and problem-solving skills to promote positive physician-dietitian interaction.

Allied Health Personnel↗
PubMed1994

Dietitian practices for adult outpatients with hypercholesterolemia referred by physicians. The Minnesota Dietitian Survey.

OBJECTIVE: To characterize the physician-to-dietitian referral process and dietitian practice patterns and opinions related to adult outpatients with hypercholesterolemia. DESIGN: Cross-sectional mail survey. PARTICIPANTS: Minnesota dietitians who treat adult outpatients referred by physicians for hypercholesterolemia. MAIN OUTCOME MEASURES: Proportion of patients for whom background information or specific diet instructions were provided by referring physicians and for whom follow-up was recommended and dietary fat content calculated by the dietitians. RESULTS: Completed questionnaires were returned by 216 of 267 eligible dietitians (81% response rate). Respondents saw, on average, 31 referred patients per month, 31% of whom were referred for hypercholesterolemia, 31% for type II diabetes mellitus, and 24% for obesity. For patients referred for hypercholesterolemia, background information was provided by physicians 37% of the time, and specific diet instructions 15% of the time. One or more follow-up visits by the dietitians were recommended for 42% of patients referred for hypercholesterolemia, compared with 60% and 70% of patients referred for diabetes and obesity, respectively. The average number of additional visits within 6 months of the initial consultation recommended by dietitians was 2.0 for patients referred for hypercholesterolemia, 3.5 for patients referred for diabetes, and 6.7 for patients referred for obesity, and the number of visits that occurred was half or less than that recommended. Dietary fat content was calculated by the dietitians for only 25% of patients referred for hypercholesterolemia. CONCLUSIONS: For adult outpatients referred to dietitians for hypercholesterolemia, relevant patient information is usually not provided by referring physicians, the number of follow-up visits is well below what would reasonably be expected to produce significant and sustained eating behavior change, and calculation of dietary fat content is generally not done. More research is needed to determine appropriate nutrition intervention protocols for these patients.

Adult↗
PubMed1994

Physicians' implementation of dietitians' recommendations: a study of the effectiveness of dietitians.

OBJECTIVE: To determine how often dietitians' recommendations were implemented by physicians and to identify workplace and demographic factors that correlated with successful implementation of recommendations. DESIGN: A cohort of hospitals was surveyed by mail. Dietitians recorded recommendations written in five consecutive medical record entries and sent them to the chief clinical dietitian. Seventy-two hours later, physicians' order sheets were reviewed to assess implementation. Dietitians completed demographic questionnaires. SUBJECTS: Forty-four general hospitals in Philadelphia and the surrounding area were surveyed. To ensure similar standards of nutrition care, only hospitals approved by the Joint Commission on Accreditation of Healthcare Organizations were selected. STATISTICAL ANALYSIS PERFORMED: chi 2, Fisher's exact test, and the Kruskall-Wallis test were used to correlate demographic variables with implementation rate. MAIN OUTCOME MEASURE: Implementation of the dietitians' recommendations by physicians' orders. RESULTS: Responses were obtained from 35 of the 44 hospitals and 98 (70%) of the clinical dietitians. Of the 865 recommendations, 42% were implemented. Significantly higher implementation rates were noted for recommendations solicited by (50%) or discussed with the physician (65%). Dietitians were more successful in teaching hospitals and when they reported to a hospital-operated foodservice rather than a contract foodservice. Success correlated with a lower workload when measured by the ratio of admissions to staff but not when measured by the ratio of beds to staff. CONCLUSIONS: Dietitians could have a greater effect on nutrition care by discussing recommendations with physicians. Further research is needed about staffing formulas and methods to improve the effectiveness of dietitians.

Adult↗
PubMed1997

The role of clinical dietitians as perceived by dietitians and physicians.

OBJECTIVE: The purpose of this study was to examine dietitians' and physicians' perceptions regarding the role of clinical dietitians. SUBJECTS AND DESIGN: Four hundred ten physicians and clinical dietitians were randomly identified from the American Board of Medical Specialties Directory of Board Certified Medical Specialists and from Michigan district dietetic association directories. A survey containing demographic, situational, and role and responsibility questions was administered. STATISTICAL ANALYSES PERFORMED: Cronbach's alpha coefficient was computed to determine the internal consistency of the measurement instrument. A series of two-tailed t tests was performed to determine between-group differences on the perception questions. Analysis of covariance was completed to control for potential confounds. chi 2 Tests were performed to determine the relationship among a change of diet order question and participants' occupation, area of specialty, and practice setting. RESULTS: Of the surveys mailed, 73% were returned and 58% overall were usable. The internal consistency of the measure was .72. Most dietitians' and physicians' responses to the role and responsibility questions differed significantly, with particularly large differences noted for 6 of 10 questions; however, "total score" differences were not significant. Significant associations were found for the level of specialization and type of occupation on the change of diet order question. APPLICATION/CONCLUSIONS: Routine contact, communication, and interaction between physicians and dietitians are vital if physicians are to know dietitians' responsibilities and competencies and collaborate with them when providing medical nutrition therapy to patients. Future studies that differentiate areas of responsibility of clinical dietitians and inquire into dietitians' and physicians' interactions during their education or training may provide further insights into this topic.

Cross-Sectional Studies↗
PubMed2001

Dietitians and the internet: are dietitians embracing the new technology?

BACKGROUND: Internet use is increasing and in the future it will become a valuable tool for health professionals seeking and communicating health, diet and nutritional information. This study aimed to explore the use of the Internet by dietitians in the UK. METHODS: A cross-sectional study was carried out on a random sample of 200 dietitians selected from the British Dietetic Association database. A self-completion questionnaire was distributed to determine access to the Internet and the views of dietitians on the use of the Internet for the provision of health and nutrition information. RESULTS: Of the 156 respondents to the questionnaire, 96% were female and 4% were male. The results revealed that 66% of respondents had access to the Internet at work, with 39% using the Internet once a week or more. The main reported uses of the Internet were searching for health information, research and communication. Thirteen per cent of respondents reported seeing information obtained from the Internet by patients. Concerns about the use of the Internet for the provision of health information centred on creating unrealistic patient expectations. CONCLUSION: The research revealed that the Internet does have a role in augmenting current services. A substantial proportion of the dietitians studied were already using the Internet routinely in their work, with the real potential for its use beginning to be realized.

Adult↗
PubMed1994

Professional roles of dietitians: do dietitians and physicians agree?

In some quarters, dietitians and physicians do not agree on a role for dietetic practitioners. Dietitians seem to be more highly regarded, and their counsel is sought and advice heeded when both health professionals work on developing collegial relationships. Education matters: a course in nutrition for physicians-to-be and more depth in the sciences for dietetic students are major factors in establishing partnerships in patient care.

Attitude of Health Personnel↗