Describing Energy Expenditure in Children with a Chronic Disease: A Systematic Review.

Understanding energy expenditure in children with chronic disease is critical due to the impact on energy homeostasis and growth. This systematic review aimed to describe available literature of resting (REE) and total energy expenditure (TEE) in children with chronic disease measured by gold-standard methods of indirect calorimetry (IC) and doubly labeled water (DLW), respectively. A literature search was conducted using OVID Medline, Embase, CINAHL Plus, Cochrane, and Scopus until July 2023. Studies were included if the mean age of the participants was ≤18 y, participants had a chronic disease, and measurement of REE or TEE was conducted using IC or DLW, respectively. Studies investigating energy expenditure in premature infants, patients with acute illness, and intensive care patients were excluded. The primary outcomes were the type of data (REE, TEE) obtained and REE/TEE stratified by disease group. In total, 271 studies across 24 chronic conditions were identified. Over 60% of retrieved studies were published >10 y ago and conducted on relatively small population sizes (n range = 1-398). Most studies obtained REE samples (82%) rather than that of TEE (8%), with very few exploring both samples (10%). There was variability in the difference in energy expenditure in children with chronic disease compared with that of healthy control group across and within disease groups. Eighteen predictive energy equations were generated across the included studies. Quality assessment of the studies identified poor reporting of energy expenditure protocols, which may limit the validity of results. Current literature on energy expenditure in children with chronic disease, although extensive, reveals key future research opportunities. International collaboration and robust measurement of energy expenditure should be conducted to generate meaningful predictive energy equations to provide updated evidence that is reflective of emerging disease-modifying therapies. This study was registered in PROSPERO as CRD42020204690.

The Value of Programmatic Assessment in Supporting Educators and Students to Succeed: A Qualitative Evaluation.

BACKGROUND: Programmatic assessment has been proposed as the way forward for competency-based assessment, yet there is a dearth of literature describing the implementation and evaluation of programmatic assessment approaches. OBJECTIVE: To evaluate the implementation of a programmatic assessment and explore its ability to support students and assessors. DESIGN: A qualitative evaluation of programmatic assessment was employed. PARTICIPANTS/SETTING: Interviews with graduates (n = 8) and preceptors (n = 12) together with focus groups with faculty assessors (n = 9) from the one Australian university explored experiences of the programmatic approach, role of assessment in learning, and defensibility of assessment decisions in determining competence. ANALYSIS PERFORMED: Data were analyzed into key themes using framework analysis. RESULTS: The programmatic assessment increased confidence in defensibility of assessment decisions, reduced emotional burden of assessment, increased value of assessment, and identified and remediated at-risk students earlier when philosophical and practice shifts in approaches to assessment were embraced. CONCLUSIONS: Programmatic assessment supports a holistic approach to competency development and assessment and has multiple benefits for learners and assessors.

Moderation of a foodservice assessment artefact in nutrition and dietetics programs.

AIM: Foodservice is a key component of dietetics education and practice internationally yet benchmarks for competency are limited. This study sought to review and moderate an assessment artefact of foodservice work integrated learning (WIL) to develop a shared understanding of one tool which may be used in a suite of evidence to demonstrate competence. METHODS: The foodservice curricula and assessment artefacts were described for the foodservice program at each of four participating universities. An assessment artefact from WIL, the report, was identified as an indicator of foodservice competence common to each program. Each university provided four purposively sampled WIL reports, assessed in duplicate by two academics from other participating universities using the corresponding university assessment rubric. Collated assessment results, along with the original assessment, were presented back to assessors. A semi-structured group discussion explored variations in assessment results, factors influencing decisions, and potential changes needed for assessment documentation. RESULTS: There was variation in assessment outcomes between independent assessors. In some instances assessors did not consistently deliver the same assessment outcome, nor rank students in sequential order of performance. This variation was less where an absolute ranking of satisfactory/unsatisfactory was applied. The assessor discussion revealed three key concepts: importance of understanding the project scope; challenges which influence assessment decision making; importance of understanding the broader program of assessment. CONCLUSIONS: Assessment inconsistencies emphasise the importance of multiple assessors and assessment artefacts across a programmatic assessment model, and the need for a clear understanding of competence in nutrition and dietetics.