PEN eNews 9(4) November 2019
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.
School Nutrition - Are you up on the latest evidence?
The PEN School Nutrition Knowledge Pathway has just been updated! Click here to see information on:
- Key elements and barriers in developing, implementing, monitoring and evaluating school nutrition policies and interventions
- Promising practices for the development of nutrition-related policy language
- School readiness and school climate for nutrition interventions
- Evidence that the implementation of school nutrition policies and interventions improves the nutritional intake of school aged-children
- School nutrition interventions and the impact on academic performance
- The impact of school nutrition policies/guidelines on the prevalence of overweight/obesity among children and youth
- The use of behavioural changes and BMI to evaluate school nutrition interventions.
To see what else is new or updated in the PEN System, click here
PEN Content Reviewers Needed
We are currently looking for reviewers for these topics:
Gerontology November 1, 2019
Low Carbohydrate (not Ketogenic) and Diabetes November 1, 2019
Intestinal Permeability November 1, 2019
Dementia November 15, 2019
There are currently more than 300 PEN Reviewers. We would love for you to join this group and share your expertise and energy. For more information, contact http://www.pennutrition.com/BecomeAuthor.aspx.
PEN Summary of Recommendations and Evidence:
Where Evidence and Practice Guidance Meet
Short on time, but need a quick and comprehensive overview of the evidence on a topic area? The Summary of Recommendations and Evidence (SRE) is your new favourite tool. The SRE organizes all of the questions in a knowledge pathway by topic. It is your one-stop shop to find the key practice points (including recommendations and graded evidence) for the topics covered in the knowledge pathway. The SRE replaces the Evidence Summary, which was a synthesis of just the evidence part of the key practice points, organized by evidence grade level. The SRE is a stand-alone tool and is mirrored in the Practice Guidance Toolkit, replacing the Key Findings and Recommendations section.
There are now 203 Knowledge Pathways in the PEN System, which means that we have many SREs to create! So far, we have created more than 80! The remainder of SREs will be in the former Evidence Summary format until content in those KPs are updated or new content is added.
Here are some examples of the new Summary of Recommendations and Evidence:
Adapted from a December 2018 PEN eNews article.
Mercury in Fish – Is it Safe?
The regular consumption of fish can be part of an overall healthy diet, but what about the mercury? See these updated practice questions to find out:
Coming Soon... new and updated content:
- Cardiovascular Disease
- Chronic Kidney Disease
- Eating Together
- Food Allergies - High Risk Infant
- Healthy Weight/Obesity - Pediatrics/Paediatrics.
What is the Latest with Lupus and Vitamin Supplements?
The QuestionDo vitamin or mineral supplements play a role in the treatment of systemic lupus erythematosus (SLE)?
Vitamin D and Calcium
A 2017 systematic review of four clinical trials (n=480) found that vitamin D supplementation (400 IU/day to 500,000 IU/week) significantly improved disease activity in two RCTs and fatigue in one RCT in adults with SLE. Disease activity and fatigue were not measured in the two studies that did not show an improvement.
A 2015 systematic review of clinical practice guidelines and expert consensus statements included one guideline that recommended calcium and vitamin D supplements to prevent corticosteroid-related osteoporosis and one guideline that recommended regular assessment of calcium and vitamin D intake. The 2018 British Society for Rheumatology guidelines for SLE management in adults recommend adequate vitamin D3 intake and regular monitoring of vitamin D status. Dosage was not specified for calcium or vitamin D.
Retinoic Acid, B6 and Vitamin C
A 2017 narrative review included case reports that suggested that retinoic acid may improve proteinuria in adults with lupus nephritis. One cohort study suggested that dietary intake of vitamin C is inversely associated with disease activity, and another cohort study found that vitamin B6 supplements (≥1.7 mg/d vitamin B6) may suppress inflammation and reduce SLE flares.
Grade of Evidence C
Vitamin D and Calcium
There is a fair amount of moderate quality evidence to suggest that vitamin D supplementation can decrease disease activity and fatigue and reduce the risk of corticosteroid-related osteoporosis in people with SLE and that vitamin D status should be monitored in people with SLE. Of ten guidelines surveyed, one recommended vitamin D and calcium supplementation to prevent corticosteroid-related osteoporosis while four more recommended regular monitoring of vitamin D status in all adults with SLE.Retinoic Acid, B6 and Vitamin C
Other vitamins or minerals that may benefit people with SLE include retinoic acid, vitamin B6 and vitamin C. Evidence for these supplements is sparse and of low quality.
To see the rest of the new and updated Systemic Lupus Erythematosus Knowledge Pathway content, click here
thank you to our PEN® volunteers
Our global PEN® partnership has benefited from volunteer efforts around the world. Please take a moment to read and acknowledge your colleagues who have served as authors, or peer reviewers for PEN content since December 2015, as well as the International Working Groups.
Kristen Di Lullo
Laurie A Wadsworth
Want to see your name amongst dietetics thought leaders from around the world? Become a PEN® author or reviewer! Please click here to send us your contact information.
why i use PEN® content alerts
Does your clinical practice always reflect best practice and evidence? If you said no, you are not alone. Many healthcare professionals do not provide care that is recommended or that is based on the latest research (1). Information overload, inaccessibility (1) and lack of awareness of new information (2) are just some of the reasons for this evidence-to-practice gap.
A Cochrane review evaluated the effects of automatic reminders for healthcare professionals on both processes of care (related to the healthcare practitioner’s practice) and outcomes of care (related to the health care condition) and found that reminders improved professional practices by 7% (1). They concluded that reminder interventions can improve care in many settings under different conditions.
This study made me think about the monthly dietetic practice reminders I receive. On the last day of each month, I receive an email alerting me to new and updated content in the PEN® System. Called PEN® Content Alerts, this Alert is customized to information that is most relevant to my areas of practice. For example, this past month, I was alerted to this resource: Learn How to Eat Mindfully with the ‘Eat—Mojis’. Without the Alert, I would not have been aware of this new (and on-trend) nutrition resource.
In previous alerts, I learned about the Microbiota Background, the Genetically Modified Organisms (GMO) Background and more! Whether it is a handout, a resource, a practice question, a general backgrounder or a Trending Topic, these Alerts have served as practice inspiration to maintain and enhance my nutrition knowledge in this ever-evolving field of nutrition.
If you haven’t already done so, sign up for PEN Content Alerts (instructions are here), a feature available to those with individual PEN® System access. Once you receive your alert, grab a cup of tea, your computer or tablet, and continue to close the evidence to practice gap in your practice.
- Cochrane. The effect of automatically generated reminders delivered to providers on paper on professional practice. This version published: 2012; Review content assessed as up-to-date: July 18, 2012. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050327/
- Bauer J. Closing the Evidence to Practice Gap. PEN eNews 4(2). August 2014. [accessed Oct. 26 2016]. https://www.pennutrition.com/enews.aspx?id=29#276
Kristyn Hall MSc, RD
Adapted from a November 2016 PEN eNews article
November 2019 Volume
A Publication of the PEN® System Global Partners,
a collaborative partnership between International Dietetic Associations.
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