PEN eNews 3(5) February 2014
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.
February 2014 · Volume 3, Issue 5
Steering the Train Back to Nutritional Sciences
Dietitians are making a media splash in the first half of 2014! Around the world, the profile of dietitians will be raised through various advocacy campaigns, designed to address “local” nutrition issues (though I think we all face similar nutrition issues):
Our colleagues down under will lead the media splash in February with their 7th Australia’s Healthy Weight Week. This week is part of the DAA’s comprehensive obesity strategy, helping to address overweight and obesity in Australia. - Our Canadian colleagues will follow next with March’s Nutrition Month. This year’s theme is Simply Cook & Enjoy, inspiring Canadians to return to cooking basics and to involve children and youth in food preparation.
- In June, our UK colleagues will celebrate the inaugural Dietitian’s Week, as well as their on-going work with the Trust a Dietitian Campaign, highlighting the work and value of dietitians and the dietetic profession as a whole in the UK.
PEN® Website Achieves International Certification
The Practice-based Evidence in Nutrition® (PEN) Global team takes great pleasure in announcing that the PEN website earned Health on the Net (HON) Code of Conduct certification. HON is a non-profit, non-government organization dedicated to promoting credible health information on the Internet. The PEN website proudly joins other websites such as Cochrane.org and Mayoclinic.com as a source of trustworthy online health and nutrition information.
- Authority: All medical information presented on your web site must be attributed to an author and his/her training in the field must be mentioned.
- The PEN website identifies all authors and reviewers with credentials noted within each Knowledge Pathway under Pathway Contributors. The PEN content team and advisory committees are described at: About PEN
- Complementarity: A statement clearly declaring that the information on the website is not meant to replace the advice of a health professional has to be provided.
- The PEN website clearly states that the information it contains “should be used to complement, not replace sound clinical judgment.“
- Confidentiality: Respect the privacy of site users
- See Privacy Policy sections of PEN license agreement (available on every PEN page).
- Attribution: Cite the sources and dates of medical information
- All knowledge objects, e.g. questions, tools and resources, toolkits etc., in the PEN database are date stamped with last updated date, which reflects date when review and or updating has occurred.
- All practice guidance in the PEN website is referenced according to standardized procedures outlined in the PEN Writer’s Guide and PEN Style Guide (PEN access required).
- Justifiability: Justification of claims / balanced and objective claims
- PEN Protocol for Finding the Evidence
In developing the content for the PEN website, validated and refined filtered information sources including synopses, well-conducted systematic reviews (such as Cochrane Reviews) and reputable practice guidelines form the basis for the evidence synthesis. Where filtered sources fail to address practice questions, PubMed is used to identify relevant and scientifically valid articles for analysis and synthesis. Extensive web searches for grey literature and unpublished resources also are used to find other relevant materials. - Evidence Grading
Key practice points in the PEN website have been assigned an evidence grade by the Knowledge Pathway author using an Evidence Grading Checklist.
- Transparency: Accessibility, provide valid contact details
- The PEN web site is set to be available during core business hours (to support two Canadian Dietitian Contact Centres) and achieves this target 99.9% of the time. Maintenance (migrating changes to production) is scheduled once a month, on the last weekend of the month, to minimize user downtime and interruptions.
- Contact Us is available on every PEN web page. Customer Service response times are monitored to ensure the target of 85% of contacts are addressed in less than 72 hours. PEN Client Services consistently meet or exceed this target.
- Financial disclosure: Provide details of funding
Funding
It is essential that the development of evidence-based tools for practice guidance be not biased through the influence of commercial entities that may stand to benefit from the service and its recommendations. As such, DC does not accept corporate sponsorship for the production or updating of practice guidance provided in the knowledge pathway content of PEN. DC does not host or receive funding from advertising or from the display of commercial content on the PEN website. All PEN authors and reviewers are required to complete a Declaration of Affiliations and Interests Form that is kept on file with Dietitians of Canada.
Funding for the PEN database has been provided by professional associations, subscription and licensing revenues, government grants and health authorities. See: http://www.pennutrition.com/contributors.aspx
- Advertising: Clearly distinguish advertising from editorial content
- As above: DC does not accept corporate sponsorship for the production or updating of practice guidance provided in the knowledge pathway content of the PEN® system. DC does not host or receive funding from advertising or from the display of commercial content on the PEN® website.
- See About PEN
Welcoming Ireland to the PEN® family
On December 4th we welcomed the dietitians in Ireland to the PEN® family. The INDI (Irish Nutrition and Dietetic Institute) annual general meeting in October launched PEN to the membership, with a presentation by Pauline Douglas from the BDA. Such excitement was raised by this meeting that INDI members were enthusiastically discussing PEN at clinical meetings in the UK all during the run up to the launch.
What's New in PEN®
New Knowledge Pathways
Updated Knowledge Pathways
New Practice Questions
- Do individuals who eat soy foods or take soy supplements have more adverse effects than those who do not?
- Do men who consume soy (foods or supplements) have more fertility/reproductive problems than men who do not consume soy?
- What are the benefits and risks for exercise for individuals with type 2 diabetes?
Updated Practice Questions
- Are pregnant women more at risk for serious health outcomes when exposed to foodborne pathogens than non-pregnant women or men? If so, what steps should be taken to reduce risk of foodborne illness?
- What are the energy and protein requirements of non-obese (i.e. healthy weight or underweight) critically ill adults?
- What are the benefits and risks for exercise for individuals with type 1 diabetes?
News-making Evidence
Professional Tools
- Osteoporosis Web Links
- Building Competency in Diabetes Education: The Essentials (Canada)
- Self-Monitoring of Blood Glucose Recommendation Tool for Healthcare Professionals (Canada)
- Bariatric Surgery and Pregnancy
- Diabetes UK Position Statement: Self Monitoring of Blood Glucose for Adults with Type 1 Diabetes
- Guidance on Cancer Services: Improving Outcomes in Head and Neck Cancers - The Manual (UK)
- Scored Patient-Generated Subjective Global Assessment (PG-SGA)
- Malnutrition - Is Your Patient at Risk? (Australia)
Client Tools
- High Potassium Eating (Canada)
- Eating Guidelines for Increasing Your Child’s Energy and Protein Intake (12 mo –4 yrs) English French
- Diabetes UK: Carbohydrate Reference List
- Healthy Eating Guidelines for Your Vegetarian Toddler (1-3 years old) (Canada) French Chinese Punjabi Spanish Vietnamese
- Diabetes UK: Tracker Smartphone App
- Eating Guidelines for People Who Have an Ileostomy (Canada) English French
- Eating Guidelines for People Who Have a Colostomy (Canada) English French
What’s New in the PEN® Database?
Each year, the PEN® database grows in breadth and depth. Here is how we grew in 2013:
• 5 New Knowledge Pathways
• 14 Updated Knowledge Pathways
• 26 New Practice Questions
• 140 Updated Practice Questions
• 171 New Client Tools
• 26 Updated Client Tools
• 168 New Professional Tools
• 128 Updated Professional Tools
At the end of 2013, the following was available to PEN® users:
• 172 Knowledge Pathways
• 1075 Practice Questions
• 1150 Client Tools and Resources
• 1075 Professional Tools and Resources
You are there to support your clients. We are here to support your practice. We look forward to answering your practice-based questions in 2014!
How do I…customize PEN Client Handouts?
The PEN® Handout Collections are a collection of client handouts ranging in topic from Health Condition/Disease, Healthy Eating/Lifestyle, PEN® Food Allergy, to Culturally Adapted and Translated Handouts.



The PEN® Team’s Surprising Findings of 2013
The field of nutrition and dietetics is vibrant and ever-changing. At the end of each calendar year, it is helpful to pause and reflect on how the nutrition
and dietetics field has evolved. The PEN® team reflected back on the evidence analyses completed in 2013, and share a few surprising findings:
I may know…I mean, I Know Something About Nutrition
Imagine you’re sitting in a convention centre and an announcement comes on the PA system, “Attention: An asteroid may hit this building.” What do you do? Probably nothing. What if the message was, “Attention: It is very likely that an asteroid will hit this building shortly”? I bet you’re out of your seat in a hurry! Why?
Twitter:
Follow @pennutrition
@dietitiansCAN (DC)
@BrDieteticAssoc (BDA)
@HealthyWtWk (DAA)
@DAA_Feed (DAA)
Facebook:
PEN®
Dietitians of Canada
Dietitians Association of Australia
British Dietetic Association
Interested in using social media? We have resources to help you engage in social media professionally and confidently.
Get ready to tweet for Australia’s Healthy Weight Week #AHWW
The Dietitians Association of Australia (DAA) is gearing up for Australia’s Healthy Weight Week, 17-23 February 2014. The week aims to encourage and inspire all Aussies to eat better, feel better and to see an Accredited Practising Dietitian (APD). This year’s campaign is targeted at 25-50 year-old adults, with a specific focus on healthy home cooking and choosing the correct portion sizes.
PEN® eNews Fact
On January 5, our PEN® Facebook post went viral. At that time, we had 2470 followers, and our post reached 3,132 people! This post was in relation to a surprising finding from 2013, highlighted in the article PEN® Team’s surprising findings of 2013.
Bringing the benefits of Wiki to PEN® Evidence-based practice guidelines
WHAT evidence-based guidelines were needed?
The prevalence of malnutrition in patients with head and neck cancer is high. Consequently, nutrition interventions play a crucial role in best practice care of this complex patient group.
- tumour location and burden
- pre-morbid nutritional status and intake
- lifestyle factors such as tobacco and alcohol abuse
- side-effects of multi-modal treatment regimens.
- immune function
- post-operative infection rates
- treatment completion
- unplanned admissions
- length of stay
- quality of life.
WHO was involved?
Developed in partnership with the Clinical Oncology Society of Australia (COSA), an enthusiastic Dietetic Steering Committee comprised of 13 Dietitians (12 Australian and 1 British) with expertise in clinical, research and/or evidence-based practice guideline development worked in consultation with an Australia-wide Multidisciplinary Steering Committee comprised of key disciplines:
- Allied Health Professionals including Dietetics and Speech Pathology
- Head and Neck Surgery
- Medical Oncology
- Oral Medicine
- Palliative Care
- Psycho-Oncology
- Radiation Oncology
- Consumer Representation.
HOW were the guidelines developed?
Traditional guideline development methodology was used to critically appraise the literature to determine both the level and quality of evidence.
- At the time of development, a systematic review of the literature identified 288 studies for independent critical appraisal revealing high-level evidence for the benefits of nutrition intervention. Since the guidelines were published online, new research has since been added to ensure currency.
- The body of evidence was assessed to determine the grades of recommendations addressing 27 clinical questions throughout the nutrition care pathway.
- The guidelines are presented in the format of clinical questions and evidence-based recommendation statements related to the nutritional management of patients primarily undergoing treatment of curative intent for primary mucosal head and neck cancer, although patients undergoing palliative treatment are also considered.
WHY Wiki?
The purpose of developing these guidelines was to provide the multidisciplinary team (MDT) with a summary of the best available evidence for nutrition interventions in patients with head and neck cancer to ultimately improve clinical, cost and patient-centred outcomes.
- web-based dissemination internationally
- diverse collaboration
- interactive consultation
- high level stakeholder engagement
- rapid updates
- version control and audit trail
- ease of maintaining currency
- greater transparency and efficiency
- reduced costs
- professional endorsements.
- The guidelines have been accessed by 64 countries to date, with the majority from Australia, UK, Canada and New Zealand.
- The most frequently visited sections of the guidelines have been malnutrition screening/nutritional assessment and the summary of recommendations.
WHEN were the guidelines developed, published and updated?
Commencing in 2009 with project funding from the Cancer Institute New South Wales administered under the auspices of COSA, the guidelines were first published online in June 2011 with maintenance and updates facilitated by the Wiki technology currently ongoing.
WHERE are the guidelines available?
We are excited to see the inclusion of the guidelines which are now available on the PEN® database in the Head and Neck Cancer Background document via a link to the COSA Wiki Guidelines page.
WHAT's next?
The Wiki platform has proved successful in ensuring currency through facilitating collaboration and online public consultation.
by Melanie Ho
Evidence-based practice is about integrating clinical expertise with scientific evidence and client’s interests to provide high quality and client-oriented care. The best evidence includes clinically relevant research with strong design, clear methodology and sufficient sample size. In practice, we come across questions where we need to seek answers that are supported by the best current evidence. It can be a long and tedious process to search and analyze all the research that is available about the topic. With the PEN® database, all the work is done and the answer is presented in a clear and concise manner.
- Their “International Collections” such as the international alcohol consumption guidelines, provide a list of the guidelines in all the PEN® partner countries.
- The “Toolkits” are very handy in clinical practice for nutritional assessment and interventions.
Hot Off the Press: New PEN® Writer’s Training Modules
Although these are hot off the press, the new PEN® Tutorials are my most frequently used, cited and forwarded PEN® resource! Developed to initially to support any PEN author, including members of the new allergy and nephrology international working groups, their potential for use is much wider. These training modules give subscribers a concise introduction to the PEN® format, and demonstrates knowledge transfer principles in presenting the background understanding required of PEN content reviewers and authors as elearning training and refresher modules.
PEN® eNews Fact
The new PEN® international working groups include dietitians with expertise to a specific topic areas from across all the partner countries who are working collaboratively to synthesize evidence for a practice areas.
Introducing the DAA’s PEN® Advisory Committee
The Dietitian’s Association of Australia (DAA) has a new Advisory Committee. PENAC (Practice-based Evidence in Nutrition® Advisory Committee) has very recently been formed and will provide strategic guidance to the DAA Board and PEN global team regarding the enhancement, promotion and evaluation of the PEN® database locally and internationally. The responsibilities and functions of PENAC are to:
- Collaborate on the PEN global content plan
- Contribute to PEN evaluation strategies
- Provide advice on new developments in knowledge transfer and/or evidence-based practice
- Provide advice to support marketing of PEN
- Provide input on proposed PEN products or services.
- Increasing awareness and subscriptions to the PEN® database including university site licenses
- Increasing contributions (review and authoring) from DAA and Dietitians NZ members and DAA interest groups
- Presenting a PEN® workshop at DAA National conference targeting new PEN® users
- Participation in evaluation of the PEN® database with the PEN® global team

Announcements from PEN
The PEN® Team would like to say congratulations!
The Cochrane Collaboration has formed a partnership with Wikipedia to promote the use of high-quality and independent evidence in Wikipedia articles! This partnership will facilitate the high-quality Cochrane evidence in reaching new audiences. Congratulations! More information is available https://en.wikipedia.org/wiki/Wikipedia:COCHRANE/WIR
Coming Next Issue
The PEN® Database and the UK Media PEN®’s Accomplishment in 2013-2014 How do I…reference PEN®?
Contact Us
February 2014 ·
Volume 3
(5)
A Publication of the PEN System Global Partners,
a collaborative partnership between International Dietetic Associations.
Copyright Dietitians of Canada. All Rights Reserved.