Experience with the management of patients requiring home enteral nutrition in routine clinical practice in Spain: the ECONES study / Experiencia en el manejo de pacientes que requieren nutrición enteral domiciliaria en la práctica clínica habitual en España: el estudio ECONES

Introduction: enteral nutrition is an effective method for restoring the nutritional status in patients unable to eat or fulfil nutritional requirements orally. Objectives: the ECONES study aimed to describe the treatment of patients requiring home enteral nutrition (HEN) in routine practice and the experience of specialists with the high-protein hypercaloric formula 2.0 with fiber IS50 (HP/HC 2.0). Methods: Spanish specialists answered a 38-questions survey about their last six patients with HEN and their treatment with HP/HC 2.0 formula. Results: the formulas were chosen based on the patients’ requirements. HP/HC 2.0 was administered in a mean of 31.5 % of patients, and for a mean of 42.2 % of those, it was selected since the beginning of treatment. According to 92.4 % of specialists, the HP/HC 2.0 was considered as adequate based on nutritional requirements. Among adverse reactions, specialists reported diarrhea, bloating and constipation. Specialists reported that caregivers (90.6 %) stated that HP/HC 2.0 was well tolerated by patients (90.6 %) and expressed comfort with the frequency (75.3 %) and administration time (82.9 %).Conclusions: according to the specialists, formulas are chosen based on patients’ characteristics. Patients with high nutritional needs benefit from the HP/HC 2.0 formula as it allows volume restriction, presents few adverse events, and improves the quality of life of the patients. (AU)

Introducción: la nutrición enteral es un método eficaz para restaurar el estado nutricional en pacientes que no pueden comer o satisfacer los requerimientos nutricionales por vía oral.Objetivos: el estudio ECONES tuvo como objetivo describir el tratamiento de pacientes que requieren nutrición enteral domiciliaria (NED) en la práctica habitual y la experiencia de especialistas con la fórmula hipercalórica hiperproteica 2.0 con fibra IS50 (HP/HC 2.0).Métodos: los especialistas españoles respondieron a un cuestionario de 38 preguntas sobre sus últimos seis pacientes con NED y su tratamiento con fórmula HP/HC 2.0.Resultados: las fórmulas fueron elegidas en función de los requerimientos de los pacientes. Se administró HP/HC 2.0 en una media del 31,5 % de los pacientes, y se seleccionó desde el inicio del tratamiento para una media del 42,2 %. Según el 92,4 % de los especialistas, se consideró la HP/HC 2.0 adecuada en función de las necesidades nutricionales. Entre los acontecimientos adversos, destacaron la diarrea, hinchazón y estreñimiento. Los especialistas indicaron que los cuidadores (90,6 %) afirmaron que la HP/HC 2.0 fue bien tolerada por los pacientes (90,6 %) y expresaron comodidad con la frecuencia (75,3 %) y con el tiempo de administración (82,9 %).Conclusiones: según los especialistas, las fórmulas se eligen en función de las características de los pacientes. Los pacientes con altas necesidades nutricionales se benefician de la fórmula HP/HC 2.0, ya que permite la restricción de volumen, presenta pocos acontecimientos adversos y mejora la calidad de vida de los pacientes. (AU)

Protocolo de educación nutricional en el tratamiento de los trastornos de la conducta alimentaria en el ámbito clínico y asistencial / Nutritional education protocol in the treatment of eating disorders in the clinical and care settings

La educación nutricional (EN), dentro del tratamiento de los trastornos de la conducta alimentaria (TCA), juega un papel fundamental ya que contribuye a que el paciente modifique sus actitudes y rutinas en relación con la comida, pierda miedos y restablezca un patrón de alimentación saludable, favoreciendo de este modo su recuperación nutricional. Sin embargo, existe falta de consenso y estandarización acerca de los procedimientos para llevarla a cabo. El objetivo de este trabajo es elaborar un protocolo consensuado de EN en el contexto del tratamiento de los TCA que permita ayudar a la toma de decisiones sobre: los pacientes candidatos a recibirla, los agentes (familia, comunidad escolar) y profesionales implicados, los ámbitos de implementación de la intervención, la información sobre los pacientes que es necesario conocer, los temas, objetivos y contenidos a trabajar, y la necesidad de evaluación de la progresión del paciente y los programas desarrollados. (AU)

Nutrition education (NE), as part of the treatment of eating disorders (EDs), plays a crucial role in helping patients to change their food attitudes and routines, lose fears, and recover a healthy eating pattern. All these changes may contribute to improving their nutritional status. However, there is a lack of consensus and standardization concerning the procedures to teach it. This work's objective was to elaborate a consensual protocol for NE implementation in the treatment of EDs to help in decision-making regarding which patients are appropriate candidates to receive NE, the agents (family, school community) and professionals involved, and the areas in the healthcare system that are best suited for implementation. Moreover, it would help in selecting the the topics to be imparted, and in following up treatment progression. (AU)

[Nutritional education protocol in the treatment of eating disorders in the clinical and care settings]. / Protocolo de educación nutricional en el tratamiento de los trastornos de la conducta alimentaria en el ámbito clínico y asistencial.

INTRODUCTION: Nutrition education (NE), as part of the treatment of eating disorders (EDs), plays a crucial role in helping patients to change their food attitudes and routines, lose fears, and recover a healthy eating pattern. All these changes may contribute to improving their nutritional status. However, there is a lack of consensus and standardization concerning the procedures to teach it. This work's objective was to elaborate a consensual protocol for NE implementation in the treatment of EDs to help in decision-making regarding which patients are appropriate candidates to receive NE, the agents (family, school community) and professionals involved, and the areas in the healthcare system that are best suited for implementation. Moreover, it would help in selecting the the topics to be imparted, and in following up treatment progression.

INTRODUCCIÓN: La educación nutricional (EN), dentro del tratamiento de los trastornos de la conducta alimentaria (TCA), juega un papel fundamental ya que contribuye a que el paciente modifique sus actitudes y rutinas en relación con la comida, pierda miedos y restablezca un patrón de alimentación saludable, favoreciendo de este modo su recuperación nutricional. Sin embargo, existe falta de consenso y estandarización acerca de los procedimientos para llevarla a cabo. El objetivo de este trabajo es elaborar un protocolo consensuado de EN en el contexto del tratamiento de los TCA que permita ayudar a la toma de decisiones sobre: los pacientes candidatos a recibirla, los agentes (familia, comunidad escolar) y profesionales implicados, los ámbitos de implementación de la intervención, la información sobre los pacientes que es necesario conocer, los temas, objetivos y contenidos a trabajar, y la necesidad de evaluación de la progresión del paciente y los programas desarrollados.

Trends in Registered Dietitian Nutritionists' Knowledge and Patterns of Coding, Billing, and Payment.

The US health care system has been undergoing substantial changes in reimbursement for medical and nutrition services. These changes have offered opportunities and challenges for registered dietitian nutritionists (RDNs) to bill for medical nutrition therapy and other nutrition-related services. During the past 10 years, the Academy of Nutrition and Dietetics has periodically surveyed RDNs providing medical nutrition therapy in ambulatory care settings to learn about their knowledge and patterns of coding, billing, and payment for their services. In 2018, the Academy of Nutrition and Dietetics conducted the latest iteration of this survey. This article compares the results of the 2008, 2013, and 2018 surveys to examine changes in RDNs' knowledge of billing code use and reimbursement patterns over time; understand the potential influences on coding and billing practices in a changing health care environment; and understand the effects of newer practice settings and care delivery models on billing and reimbursement for medical nutrition therapy services. Results from these surveys demonstrate that during the past 10 years RDNs' knowledge of billing and coding has been stable and very low for RDNs not in supervisory roles or private practice. RDNs reported an increase in providing medical nutrition therapy services to patients with multiple conditions. Since 2013, a dramatic increase was noted in the reported proportion of reimbursement from private/commercial health insurance plans. Results also indicate that most RDNs are not aware of changes in health care payment. Individual RDNs need to understand and be held accountable for the business side of practice and their value proposition in today's health care environment.

Survey of nutritional practices in total gastrectomy and oesophagectomy procedures.

AIM: Total gastrectomy and Ivor Lewis oesophagectomy procedures are the mainstay of upper gastrointestinal cancer management. Maintenance of adequate nutritional intake is essential for positive patient outcomes. Although numerous nutritional support options exist, clear evidence-based guidelines on the optimal means and duration of nutritional support are lacking. The aim of this study is to establish preliminary data on the current perioperative nutritional practices of upper gastrointestinal surgeons performing these procedures across Australia and New Zealand. It is hoped this will help provide the platform for future research towards establishing evidence-based guidelines in upper gastrointestinal surgery. METHODS: A questionnaire exploring the nutritional practices and considerations of surgeons was developed and emailed to the members of the Australia & New Zealand Gastric & Oesophageal Surgery Association. RESULTS: A total of 27.4% of Australia & New Zealand Gastric & Oesophageal Surgery Association members completed the questionnaire. Surgeons reported inserting a jejunostomy feeding tube intraoperatively in Ivor Lewis oesophagectomy procedures 80-100% of the time, compared to only 20-39% of the time in total gastrectomy procedures. For both procedures, surgeons often refer their patients to a dietitian preoperatively, and always postoperatively. Preoperative immune-enhancing nutrition is rarely administered. Patient age and BMI are deemed to be of low importance when determining the means of nutritional support. CONCLUSIONS: This study has demonstrated the current nutritional practices employed in Australia and New Zealand for patients undergoing major upper gastrointestinal surgery. Questions remain regarding the noted differences between procedures as well as the optimal means and duration of perioperative nutritional support.

Telemonitoring to improve nutritional status in community-dwelling elderly: design and methods for process and effect evaluation of a non-randomized controlled trial.

BACKGROUND: A good nutritional status is key for maintaining health and quality of life in older adults. In the Netherlands, 11 to 35% of the community-dwelling elderly are undernourished. Undernutrition or the risk of it should be signalled as soon as possible to be able to intervene at an early stage. However, in the context of an ageing population health care resources are scarce, evoking interest in health enabling technologies such as telemonitoring. This article describes the design of an intervention study focussing at telemonitoring and improving nutritional status of community-dwelling elderly. METHODS: The PhysioDom Home Dietary Intake Monitoring intervention was evaluated using a parallel arm pre-test post-test design including 215 Dutch community-dwelling elderly aged > 65 years. The six-month intervention included nutritional telemonitoring, television messages, and dietary advice by a nurse or a dietician. The control group received usual care. Measurements were performed at baseline, after 4.5 months, and at the end of the study, and included the primary outcome nutritional status and secondary outcomes behavioural determinants, diet quality, appetite, body weight, physical activity, physical functioning, and quality of life. Furthermore, a process evaluation was conducted to provide insight into intervention delivery, feasibility, and acceptability. DISCUSSION: This study will improve insight into feasibility and effectiveness of telemonitoring of nutritional parameters in community-dwelling elderly. This will provide relevant insights for health care professionals, researchers, and policy makers. TRIAL REGISTRATION: The study was retrospectively registered at Clinical-Trials.gov (identifier NCT03240094 ) since August 3, 2017.

eHealth readiness of dietitians.

BACKGROUND: The present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia. METHODS: Two cross-sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t-tests, chi-squared tests and Z-tests were computed to compare responses from the 2013 and 2016 surveys. RESULTS: The survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported 'no role' in eHealth solutions. CONCLUSIONS: Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition-related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness.

Sustentabilidade nas unidades de alimentação e nutrição: desafios para o nutricionista no século XXI / Sustainability in food and nutrition units: challenges for nutritionists in the 21st century

Na sociedade moderna, as extensas jornadas de trabalho e a dificuldade de deslocamento têm contribuído para o aumento da realização das refeições fora de casa e por isso observa-se um grande crescimento dos estabelecimentos produtores de refeições coletivas, como as Unidades de Alimentação e Nutrição (UANs). No entanto, o crescimento dessas empresas pode gerar um impacto ambiental muito grande, se não gerenciadas de maneira adequada. O tema da sustentabilidade desponta como um assunto atual e importante dentro desse panorama, pois foca numa perspectiva de não comprometer os recursos naturais e as necessidades dos cidadãos no futuro. Para tanto, estratégias eficazes devem ser aplicadas a fim de proporcionar um ambiente sustentável, e é o Nutricionista o profissional adequado que vai elaborar e aplicar tais estratégias dentro das UANs sem comprometer o bom funcionamento das mesmas.

Educating and training a workforce for nutrition in a post-2015 world.

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals.

Perception de l'avenir de la profession de diététiste par les étudiants finissants en nutrition du Québec.

PURPOSE: The main objective is to examine the perception Quebec nutrition students have of the future of the profession based on critical incidents they have reported. METHODS: An electronic questionnaire was sent to the 158 nutrition students graduating from the three Quebec universities offering a nutrition program. The critical incident technique was chosen as the qualitative method. A theme and subtheme table was devised from the analysis of the incidents and entered into Excel to synthesize the data. Results: Positive incidents were associated with the recognition of other professionals and clients, an understanding of the scope of the profession and related opportunities, and the impact of nutrition interventions. Negative incidents mainly pertained to lack of recognition, competition, the realization that employment opportunities are limited, work conditions, and the ability to assert their roles as dietitians. Most of the incidents reported occurred during practicums. CONCLUSIONS: Leadership competencies should be developed to help dietitians take their place on care teams and create a space for themselves in the public sphere. Furthermore, practicum experiences are fundamental in the development of the image students have of the profession.

Nutricionistas en el tratamiento de la obesidad: David contra Goliat y el bisturí / The role of dietitians in the treatment of obesity: David against Goliath and the scalpel

Este artículo describe las diferentes áreas de intervención terapéutica y el rol del dietista-nutricionista en cada una de estas áreas. El incremento de la prevalencia de obesidad conlleva un incremento paralelo del número de pacientes en busca de tratamiento y representa una nueva y desafiante oportunidad de actuación para los dietistas. Las habilidades interpersonales del dietista-nutricionista juegan un papel importante en los resultados del tratamiento y merece revisión periódica y entrenamiento constante. La comprensión total de la patología y el entendimiento de cómo esta puede afectar a la vida de las personas aumentará las habilidades del dietista-nutricionista para demostrar empatía y, de esa manera, facilitar el manejo del paciente a corto y a largo plazo

A description is presented on the different areas of therapeutic intervention and the role of the dietitian in each of these. The increasing prevalence of obesity has led to a parallel increase in the number of patients seeking and receiving treatment, which represents a new and challenging opportunity for dietitians to develop innovative programs. Interpersonal skills of dietitians play an important role in the treatment outcomes, and deserve periodic review and training. A full understanding of the pathology and how this can affect people's lives, increase dietitian skills to empathize, and thereby, facilitate patient management in the short and long term to ensure a comprehensive multidisciplinary approach

Expanding oral health preventative services for young children: a successful interprofessional model.

Progressive solutions are needed to solve the oral health chronic disease problem in the U.S. The importance of oral health coupled with urgent community oral health needs, shortage of primary providers, and emphasis on interprofessional collaboration make the timing ripe for allied health training and practice in oral health preventative services. A successful model is described that addressed the unmet oral health care needs of low-income and at-risk children. The model is a guide for integrating an oral health screen, fluoride varnish, anticipatory guidance, and dental referrals into allied health practice. An alternative oral health provider approach was used to address the low rate of early caries detection, preventative oral care, and access for underserved children. A comprehensive system for the administrative and clinical components of the project, including implementation plan, clinical protocols, prescriptive authority, a dental home referral system, clinical training and competency testing, was developed. The interprofessional project increased oral health services capacity and practice acceptance of oral health screening and fluoride varnishing among dietitians. Oral health care services provide allied health practitioners with unique opportunities to impact the poor access and unmet needs of at risk children and adults and to improve overall health.