PEN eNews 4(2) August 2014

How I bridged evidence with practice

Irecently completed something I had on my life’s bucket list – a triathlon involving a 750 m swim, 20 km bike and a 5 km run. My training included several workouts each week focusing on running, biking, swimming, core strength and yoga.  Of course, an integral part of my training was nutrition – and seeing how I personally responded to different food and hydration sources before, during and after exercising.  I had many practical questions as to how I would apply the evidence - how would I set up my transition station (where you change between swim to bike and bike to run) so that I could quickly and easily access my change of clothes and my nutrition in between events (the time to do this is included as part of your race time). Where would I put my supplemental nutrition sources while on my bike so that I can easily access it while pedaling 25 km/hour? (I put my food in a baggie and taped it to my bike).  What kind of food should I bring while on my run that is small enough to go in my back pocket but that is light in weight and that my body can tolerate without GI distress?  

Kristyn Hall MSc, RD

What's New in PEN^®

How do I…use My PEN^® Favourites?

 

 

 

 

 

 

Want to save your favourite practice questions, practice guidance summaries, toolkits, evidence summaries, backgrounds and tools & resources (collectively called "knowledge objects") so they are all conveniently located in one place? There is a feature available on the PEN^® Homepage called My PEN^® Favourites* allowing you to do this!

How do I add items to My PEN^® Favourites?Once logged in, simply go to the knowledge object that you would like to make a favourite and click on the star icon  located next to the title. The star will turn yellow  and this will save the knowledge object into the My PEN^® Favourites section on the PEN^® home page. Once you have added a knowledge object into My PEN^® Favourites, all you need to do is go to the PEN^® homepage after you have logged in, and click on the My PEN^® Favourites star.  Your object will be organized by knowledge object type (Practice Question, Toolkit/Practice Guidance Summaries, Backgrounds, Evidence Summaries, Related Tools and Resources). There is no limit to how many favourites you can have.There are two ways to remove items from My PEN^® Favourites:

• start by viewing your favourites (as above).  Then, simply click on the “Manage my PEN^® Favourites” link on the right hand side.  You will be taken to a screen that will allow you to remove specific items.
• You can also remove items from My PEN® Favourites by going back to the knowledge object originally favourited and deselecting the star.
  

The PEN^® knowledge database has over 3000 resources and 1094 questions to help guide your dietetic practice.  The My PEN^® Favourites feature was created to help you quickly access your favourite and most-used knowledge objects, with a simple click of a button.  We hope that you enjoy this feature. * In order to create a unique My Favourites for a PEN^® user, the PEN^® system must tag the My Favourites to a particular username and password.  That means that the My Favourites feature is only available to PEN^® group and individual subscriptions, and not to PEN^® knowledge base users accessing PEN^® via a site license. 

Closing the evidence to practice gap  

In dietetics

Translating research into practice is an international issue challenging all health professions. This evidence to practice gap has been recognised for over 20 years and timeframes of 17 years for research to be implemented are not uncommon (1). Although there have been advances in technology which have closed some of this gap in recent years such as electronic submission of manuscripts to journals, decreased review times and early online view of accepted articles, the uptake of new evidence by practitioners remains slow. Glasziou & Haynes (2) coined the phrase ‘practice famine amid the evidence glut’ to describe this ongoing issue. 

The ICDA 2010 consensus statement on evidence based dietetic practice identifies important elements such as ‘asking questions, systematically finding and assessing the quality of evidence as well as combining that information with expertise or experiences and the client or community values to guide decision-making’. One of the key barriers is lack of awareness of new evidence. This is not surprising given that in 2013 there were over 20,000 new PubMed nutrition citations, 76 journals in the field of nutrition and dietetics (3) and many of our colleagues publish outside the field of dietetics in specialized medical journals. It is increasingly difficult to maintain currency in one area of practice, let alone have a good overview of all of the domains of dietetic practice. Dietitians need to be both aware of and savvy users of technology to advance their practice and become familiar with databases that contain synthesized information. The PEN system has evidence-based, peer-reviewed answers to practice questions across the diverse domains of dietetic practice. The historic PEN partnership of Dietitians of Canada, The British Dietetic Association and Dietitians Association of Australia is helping to close the evidence to practice gap and advance dietetics internationally. 

Even when we are aware of new evidence and accept that our practice needs to change, there may be a number of recognized implementation barriers related to the healthcare system. These may relate to policy, interdisciplinary team roles and behaviours, financial constraints, patient beliefs and expectations to name a few. It is important to identify a comprehensive list of barriers and enablers by consulting with the interdisciplinary team and other key stakeholders to ensure all issues are identified and addressed. There are a number of frameworks for behavior change interventions that can be used to identify appropriate strategies based on the sources of behavior. An excellent example is the Behaviour Change Wheel developed by Mitchie et al (4) from a systematic review of existing frameworks. It consists of a hub of essential conditions (capability, opportunity and motivation) surrounded by nine intervention functions aimed at addressing deficits in one or more of these conditions and around this are seven categories of policy that may enable the interventions to take place.  Improving the implementation of evidence based dietetics practice is a key priority for our profession and a challenge we must all embrace.

Written by:
Judith Bauer PhD, FDAA
Associate Professor, University of Queensland, Brisbane
PEN Translational Researcher Leader, DAA

Paleo, gluten free, detox diets

Dietetic descriptors that should make you curious 

Paleo, gluten free, detox diets, cleanses – these are popular words in the media and used in daily conversations describing a way of eating, or what I call “dietetic descriptors” that often elicit a visceral reaction from dietitians. Sugar-free, low carb, vegetarian, natural, raw food, and I don’t eat X, Y or Z – and there are many others. When I hear people use these words, my ears perk up, as the meaning of these words to myself, as a dietitian, versus the person using them can be very different. These dietetic descriptors are often used to identify and distinguish between “food tribes”. 
Food tribes are slightly different than cultural food habits. According to Shore (1) food tribes are “communities that are built when groups of people have shared identities based on the types of food they eat or avoid.” As can be expected, different tribes have a different perspective of what healthy eating is, and what foods should be avoided to achieve overall health. In his article, Shore outlines that people extrapolate small amounts of scientific knowledge to extremes in order to justify their behaviour. And, while this is weak research, this often results in media headlines, further fuelling “food tribalism.” (1).

The use of these dietetic descriptors can lead to the polarization of nutritional concepts - this way of eating is bad for your health, this way of eating is better – leading to consumer confusion and the questioning of basic nutrition principles or advice. As dietitians, we can use our body of scientific-based knowledge and critical thinking skills to examine the issue and offer professional insights about how a particular way of eating may impact health.

We can remain curious when we hear these dietetic descriptors being talked about in the media, in every day conversations and/or when being mentioned by our clients. Explore with people their definition and understanding of these words and how they have assimilated this information into their lives. As Fenton said (2), the meaning of “cleanse” can range from eating fewer processed and refined foods, to fasting, to boxed “cleansing” products sold in health food stores. We can also use this collected information to determine how their understanding is impacting their nutritional status and moving them toward (or away) from their health goals. A person whom is “cleansing” by reducing their intake of processed foods and eating more vegetables, fruits, whole grains, and lean proteins (2), is actually working toward their health goal. They are merely using a dietetic descriptor to explain it, though it may not be the best descriptor. A dietitian should clarify before responding or providing guidance. Whether it is cleanse, gluten-free or detox, these dietetic descriptors elicit a value-laden response from a dietitian who “assumes” that it is an extreme approach, which, upon exploration, could be a very positive approach.

As Simmons states (3), belonging to a food tribe(s) is not by itself a bad thing. But it is important to understand the nutrition information promoted by a food tribe as it may be skewed to support a shared belief and value of that food tribe. I would be interested in hearing about how you handle these dietetic descriptors in your practice. Email me at eNews@pennutrition.com 

References:

1. Shore R. Food Tribes: Making up the rules as we go. The Vancouver Sun (Weekend Review). 2014 March 15 [cited 2014 Jul 9];Sect.D:1. http://blogs.vancouversun.com/2014/03/15/food-tribes-making-up-the-rules-as-we-go/  
2. Fenton T. Responding to misleading nutrition information in a lay publication via a letter to the editor, a case study. PEN® eNews. 2013 [cited 2014 Jul 9];3(2). Available from: http://www.pennutrition.com/enews.aspx?id=14#171  
3. Simmons D. Food Tribes are Us? April 29,2014 [cited 2014 Jul 9]. Available from: https://www.healthyfamiliesbc.ca/home/blog/food-tribes-are-us

Written by: Kristyn Hall MSc, RD
PEN^® eNews Editor and Social Media Lead
eNews@pennutrition.com

Bridging evidence-based nutrition with popular media: australian media spokesperson Clare Collins

With all the buzz about nutrition in the media, we caught up with Dietitians Association of Australia (DAA) Media Spokesperson Clare Collins to ask her about her thoughts on bridging evidence-based nutrition with popular media.
How does interacting with the media affect your practice as a dietitian?

PEN Insider

Spotlight on Isabel Fischer

When I reached for the opportunity to do a three month internship in Canada, I had no clue what was to come. By the time I got introduced to the idea of splitting my internship between the PEN^® team and EatRight Ontario, my evidence-based teacher was all aflutter. She was talking elatedly about this great and huge knowledge base.  But to be honest: to me it was as clear as mud. 

Early Reflections on joining the GLOBAL PEN^® Team

Spotlight on Gail Scarlett, MPH, APD

As an Australian heath professional for more than 30 years, I had become increasingly frustrated at the rise of misinformation about science in the general community, and misinformation’s insidious infiltration into the professions. Since the 1970s, I saw an increase in ‘complemento-paths’, for example naturopaths and osteopaths. Now in the noughties (the new millennium), complementary practice groups are significant economic players in the consumption of the health dollar. Complementary medicine has infiltrated university education. Complementary and alternative-practice lobby groups vie for health dollars in private practice and from the public purse.

But then I found PEN^®, and am now a part of the GLOBAL PEN^® team as a fledgling ‘Evidence Analyst’. At last, I have worldwide fellowship of like-minded nutritionists and dietitians whose scientific training makes them champions of evidence-based practice.It was language, though, that created my first doubt about my competence for this role.‘We want you to explore GERD’ they said. ‘GERD?’ I thought. ‘What word is that?’ until ‘the little grey cells’ prompted me: ‘GORD – you idiot!’. So my first literature search challenge – don’t forget the ‘oesophagus’ is also the ‘esophagus’. To help me out, PEN^® has a writers’ guide with preferred style conventions, an orientation tutorial and an amazing team of senior writers, reviewers and editors to improve the work of ‘newbies’.My Dietetic Association of Australia (DAA) recognizes contributions to developing practice-based PEN^® questions and the development of Knowledge Pathways as part of our Continuous Professional Development (CPD). One of the hardest parts of our CPD can be accruing the ‘assessed’ CPD hours compared with self-study, workshop or conference hours. Perhaps we can make a case that PEN^® contributions meet an ‘assessed’ criterion because of the depth of peer-review that occurs before information is published as a PEN^® Knowledge Pathway on the website.PEN^® also includes toolkits and resources for dietitians’ practices. Soon, more Australian resources will be added to PEN^®, but in this instance, we need the retention of Australian language, culture and foods for these resources to be useful in Aussie populations. So, PEN^® guidelines for writing and editing resources will need to be as linguistically diverse as the 17 countries of worldwide dietitians that use or continue to grow the PEN^® Knowledge base.In conclusion, we can all practis(c)e evidence-based nutrition with the practice-based evidence in nutrition resource that is PEN^®.PEN^® Evidence Analyst, Dietitians Association Australia

thank you to our PEN^® volunteers

Announcements from PEN^®

5 Reasons why students, dietetic interns and dietitians should read PEN^® eNews:

1. Critical appraisal is an essential skill. PEN^® eNews will enhance your skills in critically appraising the literature.
2. In these times of information overload, we can all use help identifying what is the best possible care for our clients and patients. PEN^® eNews will enhance your knowledge of and participation in transferring the most valid and important research findings into practice. 
3. PEN^® is created by and for dietitians. PEN^® eNews will help you to position yourself as a leader in evidence-based nutrition practice.  
4. PEN^® is a dynamic resource. PEN^® eNews will help you keep up to date on new content, features and technology available in PEN^®.    
5. PEN^® is a powerful database with 184 knowledge pathways, 1095 practice questions, 60 toolkits and 1437 consumer and 1513 professional tools/resources and more content is added every day! PEN^® eNews will help you get the most out of the PEN^® system. 

PEN^® eNews can be accessed at www.pennutrition.com/enews

 

Coming Next Issue

Contact Us

Do you have comments, questions or feedback? Please contact us:

Jayne Thirsk RD, PhD, FDC 
Director of PEN^®
jayne.thirsk@dietitians.ca

Ingrid Darnley BSc (Hons) 
Policy Office Clinical Quality, British Dietetic Association 
globalpen@bda.uk.com

Kristy Parsons APD 
Professional Services Dietitian, 
Dietitians Association of Australia 
psd@daa.asn.au

Kristyn Hall RD, MSc 
Editor of PEN^® eNews  
Dietitians of Canada
eNews@pennutrition.com