PEN eNews 3(3) October 2013
PEN eNews is a monthly e-newsletter shared with the global PEN Community and created to help dietitians position themselves as leaders in evidence-based nutrition practice. In addition, users of the PEN System will find articles on the new evidence, resources and features available and how to maximize one's use of PEN.
October 2013 · Volume 3, Issue 3
International Collaboration
Between May and October, we have seen all four of our partner associations host their national member conferences. The Dietitians Association of Australia in May, Dietitians of Canada in June, Dietitians New Zealand in September, and the British Dietetic Association in October. Through the wonders of technology, we were able to interact with dietitians from around the world. Each day, we observe that dietitians around the globe have similar practice-based questions for which we need evidence-based answers.
As the body of research expands and literature availability explodes, we need to approach finding this answer systematically so that we can arrive at the best answer, regardless of where we are in the world. And even if we find the answer today, we need to have systems in place that help us identify when our answer needs to evolve. We need to decide how we will store our answer for future reference. Kristyn Hall MSc, RD
Editor, PEN® eNews
PEN® eNews may contain links to other external websites. PENnutrition.com is not responsible for the privacy practices or the content of such external websites. Dietitians of Canada, Dietitians Association of Australia, Dietitians New Zealand and The British Dietetic Association do not endorse the content, products or services on other websites.
What's New in PEN®
This past September, we presented a poster PEN® – The Global Resource for Nutrition Knowledge Translation at the International Union of Nutritional Sciences 20th International Congress of Nutrition in Granada (Spain). We were represented by Annette Byron from the Dietitians Association of Australia. Reiko Sugiura PhD RD from Wayo University in Japan stopped by to connect with the PEN® team. To see our poster, click http://www.pennutrition.com/resources/PEN%20Nutrition%20Global%20KT.jpgUpdated Knowledge Pathways
New Practice Questions
Updated Practice Questions
- exposed to foodborne pathogens than non-pregnant women or men?
- Are B-vitamin supplements (e.g. folic acid, vitamin B12, B6) effective in cardiovascular disease (CVD) in healthy individuals (primary prevention) or individuals with pre-existing CVD (secondary prevention)?
- What post-discharge dietary interventions can reduce the risk of
- Does calcium supplementation or increased intakes of dietary calcium or dairy products result in either weight/fat loss or less weight gain/body fat deposition over time among children and adolescents?
News-making Evidence
Professional Tools
- Current Issues: My Client is Pregnant and Now has Gestational Diabetes: As a Dietitian What Do I Do? (Canada) English French
- Diabetes Management in General Practice Guidelines for Type 2 Diabetes (Australia)
- Household Food Insecurity in Canada, 2011 (Canada)
- Low Vision - A Guide for Educators
- Nutritional Management in Children and Adolescents with Diabetes
- Food Allergy Resources for Healthcare Providers
Clients Tools
- Your Guide to the Eatwell Plate (UK)
- Cooking and Eating with Low Vision
- Safe Internal Cooking Temperatures (Canada) English French
- Dietary Management of Metabolic Syndrome (Canada)
- Food Choices for People with Diabetes (Australia)
- Healthy Hints for Modifying Recipes (Australia)
- Sweeteners (Canada)
- Sugar Alcohols - Sugar and Sweeteners (Canada)
- Living Confidently with Food Allergies (Canada)
- Food Allergy Tools for Schools
- Foodborne Illness Prevention Advice - from Public Health Agency of Canada Something You Ate? Protecting Yourself (Canada) English French
- Feeding Your Picky Toddler or Preschooler (Canada) Hindu Punjabi Spanish
How do I…use my PEN® Favourites?
Dawna Royall, MSc, RD, Evidence Analyst Contractor, PEN® Team Canada
making the grade
With the start of the school year, our thoughts turn to grading, and in particular, grading evidence. We've been hearing a lot about GRADE - the Grading of Recommendations Assessment, Development and Evaluation. In this overview, we'll look at the evidence grading approach that PEN® uses and compare it to the GRADE approach.

- study design for answering the practice question (i.e. different types of studies are applicable when considering treatment or prevention)
- quality of the studies
- consistency across studies
- clinical impact or potential benefit of applying the recommendation to a population
- generalizability to other populations
- applicability to practice settings
- High = further research is very unlikely to change our confidence in the estimate of effect
- Moderate = further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
- Low = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
- Very low = any estimate of effect is very uncertain.
- Balance between desirable and undesirable effects
- Variability or uncertainty in values and preferences
- Costs (resource utilization)
Putting Protein into Practice: The Evidence-based Practice Process in Action
Did you know that there has been an explosion of research in the field of protein nutrition in the past decade? Did you know that the nitrogen balance method should no longer be considered the “gold standard” for determining protein requirements? A lot has changed since most of us learned about protein nutrition in university. This past March we teamed up to present the latest research on protein and its practical application for older adults at the 2013 Dietitians of Canada National Conference in Victoria, BC. Upon reflection we realized that our joint effort was an exercise in putting the 5A’s of the Evidence-based Practice (EBP) Process (Ask, Acquire, Appraise, Apply and Assess) into Action. Below we each share our reflections on this process.
Jane Bellman M.Ed, RD and Kerri Staden BSc, RD, Dietitians of Canada,
Sue Firus, BHE (Dietetics), RD, Dietitians of Canada
Sue Kellie MSc, British Dietetic Association
How International Dietetics and Nutrition Terminology is Relevant to Dietetic Practice and How PEN® can Help
It may just sound like a bunch of letters, but IDNT or the International Dietetics and Nutrition Terminology is increasingly being used in dietetic practices and settings around the globe. It was designed to standardize the language used to describe the nutrition care process (NCP), and in doing so, facilitates communication between nutrition care professionals. The IDNT also facilitates better reporting (including documentation in the medical record) and monitoring of nutrition goals and outcomes1,2. Originally produced by the Academy of Nutrition and Dietetics (AND) in 2003 both IDNT and the NCP have been recommended for international adoption by the International Confederation of Dietetic Associations3 .
Using IDNT and the NCP in your practice helps to promote the dietitian and nutrition as it:- provides a model which can be used to advance decision making skills
- clarifies the dietitian’s role in the health care team by identifying specific nutrition problems that the dietitian’s nutrition intervention can address,
- provides a model for measurement of outcomes,
- aids in the education of dietetic students
- drives up standards of practice
- provides a framework for record keeping.
- Start with a read through the PEN® background: International Dietetics and Nutrition Terminology (IDNT) Background.
- Review the IDNT resources:
- DC members can access resources through the DC website after logging on. Resources include: the IDNT manual, and the Academy of Nutrition and Dietetics NCP learning tutorials.
- PEN® partner countries can find links to access IDNT resources specific for their countries at International Dietetics and Nutrition Terminology (IDNT) Web Links.
- Review and use PEN® Practice-based Evidence Toolkits (PETs). PETS are organized according to the NCP, with each step of the process having its own page in the toolkit. IDNT is used throughout the Toolkits in all four steps of the NCP:
- Nutrition Assessment - includes IDNT assessment terminology
- Nutrition Diagnosis – including information on PES (problem, etiology, signs and symptom) statements. PES statements are important in supporting dietitians to identify the main nutritional issues relevant to the pathway that will be targeted through the intervention.
- Nutrition Intervention – including nutrition prescription with additional subsections on goals, key findings and recommendations
- Nutrition Monitoring and Evaluation – key guidance for the practitioner to use to monitor and evaluate nutrition outcomes.
2Atkins M, Basualdo-Hammond C, Hotson, B. Canadian perspectives on the nutrition care process ad International Dietetics and Nutrition Terminology. Can J Diet Pract Res. 2010. [cited 2012 Oct 29];71(2):106. Available from: http://www.dietitians.ca/downloadable-content/public/ncp-and-idnt-statement-eng.aspx
3Dietitians of Canada. Website Resources. 2013 [cited 2013 Sept 27]. Available from: http://www.dietitians.ca/Member-Resources-A-Z/Member-Resources-A-Z-page/Position-Papers/Can-Perspectives-on-Nutr-Care-Process.aspx. Subscription required.
Remaining abreast of literature & giving back to the dietetic community: a dietitian’s perspective
When we were approached with the idea of collaborating with interns to contribute to a new PEN® knowledge pathway, it was a novel and exciting project for the interns and us. As dietetic preceptors, it was an opportunity to support our interns in developing research and critical appraisal skills, as well as a chance for us to remain abreast of current literature in our area of practice and give back to the dietetic community.
Interested in seeing what happens between having a practice-based question and having the answer make it into the PEN® Database? Read Birth of a PEN® Pathway on page 4 of http://pennutrition.com/pdf/NewsletterFeb2012.pdf
Student Corner:
Remaining abreast of literature and giving back to the dietetic community: a dietetic intern’s perspective
As part of any dietetic internship, a research component identifies important competencies that must be achieved. As dietetic interns at Sunnybrook Health Sciences Centre we were given the option to pursue the development of a knowledge pathway for the PEN® database as an alternative to assisting with a standard research project, generally an in-hospital clinical trial. This was a new and exciting prospect! We were drawn to the idea that we could pick our own topic, one that was of interest to us, and to the dietetic community, and about the possibility of contributing to an evidence-based, practical, and internationally utilized online resource for fellow dietitians.
- Honed our skills in critical appraisal of evidence-based literature,
- learned a significant amount about Diabetes and exercise physiology,
- improved our ability to transform high-level theoretical literature for practical applications, and finally,
- were able to disseminate this data to into a research poster format that will be shared with internal and external stakeholders in the healthcare community.
Social Media Corner: What is a Twitter Chat?
A Twitter chat is a pre-arranged live “chat” or virtual conversation that occurs between people using Twitter. All tweets discussed in a twitter chat are streamed together using a hashtag specific to that twitter chat. Think of a Twitter chat as a virtual networking meeting of people, keen to talk with each other, and exchange ideas around a specific topic. Instead of meeting “in person”, people use the social media platform Twitter to connect. They know “where” to meet because of the Twitter chat hashtag.
Since eNews 3(2), what have been some of our most popular links clicks through from twitter?
• Omega-3 fat content of common foods
• Continuous versus bolus feeding of enteral nutrition in critically ill patients – how do outcomes compare?
• Feeding our families: PEN® reviewed weblink with tips and ideas for eating on the run, evening meals, celebrations
• Are you packing a healthy lunch? Need some ideas to add more pizzazz to your #lunch box?
• September 21 is world Alzheimer’s Day. What does the evidence say about dietary approaches & dementia?
• Nutrition-related implications of cancer treatment. What dietetic practitioners can do.
PEN Insider
Spotlight on Kate Paul
Senior Professional Services Dietitian
Dietitians Association of Australia (DAA)
- Coordinating PEN® content/toolkit reviews by DAA and Dietitians NZ members
- Attending regular teleconference meetings with PEN® colleagues from DC and BDA - late, early and occasionally during business hours!
- Supporting PEN® author /writing groups to get together along with Assoc Professor Judy Bauer who is our new DAA staff member and inaugural Translational Research Leader.
- Being the primary contact at DAA National Office for all things related to the PEN® system.
- Coordinating PEN® education activities in Australia e.g. conference workshops
- Promotion of the PEN® database at DAA National Conferences
- Contributing articles to PEN® eNews.
- Evidence based practice is what sets dietitians apart from others working in the busy space of nutrition and health practice. And part of why dietitians are recognized by the public as the most valued and credible source of food and nutrition information.
- I have had experience preparing DAA submissions on a variety of nutrition policy and food regulation topics. When coordinating such a response on behalf of an organization with a diverse membership, evidence is very important. DAA aims to recommend evidence-based positions to all such opportunities to inform external policy proposals.
- There has been a long history of DAA supporting members to achieve evidence-based practice and I have supported a number of these past activities:
- DAA endorsed a number of evidence-based practice guidelines between 2003-2011.
- DAA has run numerous face-to-face professional development events on evidence based practice, eg. critical appraisal roadshow in 2011 and malnutrition guidelines roadshow in 2009.
- DAA endorses and promotes evidence-based client education resources via our members only database DINER (Dietetic Information and Nutrition Education Resources) as well as supports members to write such material.
- DAA is now focusing its efforts into supporting the PEN® database. It’s an exciting time for members. There are ongoing opportunities to review or contribute content, as well as refresh skills in critical appraisal. The PEN® database is a handy tool for dietitians in any practice setting.
- The nurturing environment! The PEN® community provides the opportunity for dietitians with clinical expertise to up-skill in the area of critical appraisal and contribute content to the PEN® database. I am enjoying working with the wonderfully supportive international PEN® team. I hope you will come and join us by signing up to use the PEN® database if you haven’t yet already.
BDA Live & Online
How can the structure of the programme and the presentations enhance the understanding of the science presented? How does the application of sound educational principles change a conference programme? Is it possible to have a paper-free conference?
These were just some of the challenges that the British Dietetic Association (BDA) conference organiser set out to answer with BDA Live and online. Speakers were chosen to provide both the science and practice of changing behaviour at all levels, policy to individual. The two days started with Professor Susan Michie of University College London providing the key note and presenting her research on behaviour change; reminding us all that any behaviour is multifactorial and needs to be understood in context. Over the next two days we tweeted, talked, consulted, discussed, reflected and questioned the science and practice of behaviour change through topics as diverse as protein requirements, dietitians’ engagement with research, leadership, school food, developing your own brand, sustainable diets, nutritional approaches to Alzheimer’s disease, story telling and obesity.We also demonstrated the power of dietitians as advocates for change. Linda Hindle from Dietitians in Obesity Management, a specialist group of the BDA, presented the Chuck Junk Off the Checkout campaign. The 70% of the delegates who picked up chocolates on the way into the session powerfully demonstrated the power of impulse and reinforced the health benefits of encouraging supermarkets and other retailers to place non-food or healthy foods at the checkout.
The conference ended with presentations from community groups, who are making a real difference for individuals and communities. Using food that would be otherwise wasted, the community groups provide nutritious meals for the vulnerable and support individuals to develop skills that help them back into employment. A powerful reminder of the power of food to change lives for the better and a fitting end to the conference
For more messages from the conference search for #BDALive on Twitter.
To support learning, participants were encouraged to engage with the topics through discussion and activities within the presentations, and space and time for was provided for reflection. And did we manage a paper free conference? Not quite. But we had no conference bag or printed programme. An App allowed us to download information from the speakers and exhibitors, vote on issues in the sessions, complete surveys, make contact with other participants, follow the programme and book meetings with other participants; and the exhibitors reduced the paper and other resources they would normally bring. It was a successful conference on many levels and we look forward to our next meeting of the minds!
Have a reflection from a recent conference you attended? Contact us at: eNews@pennutrition.com
Submitted by Sue Kellie M.Sc., Deputy Chief Executive/ Head of Education and Professional Development British Dietetic Association
Knowledge Transfer Events and Resources
Article:
Poster presentations:
Webcasts:
PEN® does not have editorial or other control over the contents of the referenced Web sites. We are not responsible for the opinions expressed by the author(s) of the knowledge transfer events and do not endorse any product or service.
Coming Next Issue 3(4)
What do the copyright and updated dates on PEN handouts mean?
How did we choose the name Practice-based Evidence in Nutrition?
Contact Us
October 2013 ·
Volume 3
(3)
A Publication of the PEN System Global Partners,
a collaborative partnership between International Dietetic Associations.
Copyright Dietitians of Canada. All Rights Reserved.