Pre-registration education and training for dietitiansReport and recommendations from the British Dietetic Association/CPSM Dietitians Board Joint Working Party, February 1996

The following report was presented to the Dietitian's Board of the Council for Professions Supplementary to Medicine (CPSM) and the Education Committee of the British Dietetic Association (BDA) in March 1996. It outlines the process by which the working group examined pre-registration education and training for dietitians in the light of their current and future role in the UK, together with the recommendations made for changes in training. These proposals were agreed by the Dietitians Board and British Dietetic Association in March 1997 and a new working group will be convened to develop detailed guidelines for education and training.     

Abstracts of the British Dietetic Association First Recent Graduates Symposium, 15 September 1999

Each year, students throughout the UK on University courses leading to Honours Degrees, with State Registration in Dietetics complete small‐scale research projects. In order to disseminate the findings of these studies and promote commitment to research amongst new entrants to the profession, a ’Recent Graduates Symposium’ was organized by the Research Committee of the British Dietetic Association at which selected projects were presented. The following abstracts indicate the wide range of topics explored, which will in some cases lead on to further research. These projects also illustrate some of the possibilities for research collaboration between practising dietitians and academic departments. Symposium Chair: Dr Moira Taylor (BDA Research Committee), Department of Nutrition & Dietetics, King’s College London Symposium Sponsors: Mars Confectionery, Novartis Nutrition UK Ltd, The Sugar Bureau, Yakult UK Ltd.     

Sucrose and fructose in the diabetic diet

Briefing paper from the Nutrition Subcommittee of the British Diabetic Association's Professional Advisory Committee
This paper reviews the available evidence on the effects of sucrose, fructose and sorbitol on metabolic homeostasis in diabetic patients and makes recommendations for the use of these carbohydrates.     

Research and evaluation: the involvement of community dietitians

The recent document Dietitians in the Community: Opportunities for the Future (BDA, 1993) highlighted the importance of strengthening the evaluation and research base of the practice of dietitians working in the community.
Members of the Community Nutrition Group of the BDA were surveyed by postal questionnaire in March 1992 to gather information to facilitate implementation of the report's recommendations. Thirty-six per cent of the members (n = 125) responded. Over half (56%) reported recent involvement in a research project and 97% expressed a need for better training and support in one or more aspects of the research process. Information was also gathered about the types of projects undertaken, preferred forms of support, previous training, evaluation and research, collaborative links and perceptions of the role of the BDA Research Committee and Metabolic Research Groups. This information is presented and discussed.
In conclusion, relatively few community dietitians are actively involved in evaluation and research. Various modes of support are necessary to increase the number of dietitians engaged in this area, if the stated commitment of professional managers and the British Dietetic Association is to be fulfilled.     

Practice paper of the American dietetic association: nutrient density: meeting nutrient goals within calorie needs

Practice Papers are evaluative summaries of scientific and/or evidence-based topics. They are meant to provide key opportunities for critical reasoning on timely topics and quality improvement in dietetics practice and to include peer-reviewed perspectives from content practitioners and other experts.How does a practice topic become a Practice Paper? Proposals may be generated by any member of the American Dietetic Association via submission of a topic identification proposal, which may be obtained by contacting ADA headquarters at 800/899-4835 or ppapers@eatright.org. The Association Positions Committee oversees the development of Practice Papers and welcomes proposals from members.     

Obesity treatment: future directions for the contribution of dietitians

The British Dietetic Association (BDA) recognizes that obesity is a serious and growing health problem in the UK. It welcomes the inclusion of reduction in the prevalence of obesity as one of the targets of the Health of the Nation (DoH, 1992). The achievement of this target will depend upon measures aimed at prevention, as well as improved treatment for obesity. State Registered Dietitians (SRDs) are qualified to provide scientifically based, independent information on nutrition and eating behaviour. They have an important contribution to make to both public health measures and health promotion, as well as to the development and implementation of more effective therapeutic strategies to help those who are already obese.     

A survey of provision of dietetic services for coeliac disease in the UK

BACKGROUND: Management guidelines for care of coeliac patients published by the British Society of Gastroenterology (BSG), 2002 recommend that patients should see a dietitian at diagnosis and at least at annual review. In the absence of information on dietetic provision in coeliac disease management in the UK and with surveys in other countries suggesting that patients with coeliac disease gain most information from coeliac support groups (Green et al., 2001), Coeliac UK set out to investigate dietetic services for coeliac patients in the UK. METHODS: Questionnaires were sent to dietetic departments in the UK via the Regional Managers Group of the British Dietetic Association (BDA) by email. The questionnaires were in two parts, the first was completed by the dietetic manager and the second by the dietitian with the main responsibility for the management of coeliac patients within the department. RESULTS: Over one-quarter of departments reported allocating a maximum of 1 h of dietitians' time per month per 100,000 population to seeing coeliac patients. More hours were allocated to coeliac patients in departments where dietitians had attended coeliac disease training, where dietitians were professional members of Coeliac UK or where coeliac patient care was undertaken by a multi-disciplinary team. CONCLUSION: There is wide variation in dietetic provision for diagnosed coeliac patients in the UK. The Coeliac UK survey suggests that the current level of dietetic provision is in the region of one-third of what is required according to the BSG management guidelines (British Society of Gastroenterology (BSG), 2002) to provide diagnosed coeliacs with only basic support and annual review.     

Field worker exposure during pesticide application

Summary An International Workshop on Field Worker Exposure During Pesticide Application was organised in The Hague from October 9–11, 1979 by the Scientific Committee on Pesticides of the International Association on Occupational Health.Papers and discussions dealt with the factors that may influence the exposure, such as the formulation, application, and personal protection and also with the measurement of exposure and biomedical effects under field conditions.A limited number of papers were concerned with various scientific subjects relevant to field worker exposure.The proceedings of this Workshop will be published by Elsevier Scientific Publishing Company in the spring of 1980     

A Model to Systematically Employ Professional Judgment in the Bayesian Decision Analysis for a Semiconductor Industry Exposure Assessment

Bayesian Decision Analysis (BDA) uses Bayesian statistics to integrate multiple types of exposure information and classify exposures within the exposure rating categorization scheme promoted in American Industrial Hygiene Association (AIHA) publications. Prior distributions for BDA may be developed from existing monitoring data, mathematical models, or professional judgment. Professional judgments may misclassify exposures. We suggest that a structured qualitative risk assessment (QLRA) method can provide consistency and transparency in professional judgments. In this analysis, we use a structured QLRA method to define prior distributions (priors) for BDA. We applied this approach at three semiconductor facilities in South Korea, and present an evaluation of the performance of structured QLRA for determination of priors, and an evaluation of occupational exposures using BDA. Specifically, the structured QLRA was applied to chemical agents in similar exposure groups to identify provisional risk ratings. Standard priors were developed for each risk rating before review of historical monitoring data. Newly collected monitoring data were used to update priors informed by QLRA or historical monitoring data, and determine the posterior distribution. Exposure ratings were defined by the rating category with the highest probability—i.e., the most likely. We found the most likely exposure rating in the QLRA-informed priors to be consistent with historical and newly collected monitoring data, and the posterior exposure ratings developed with QLRA-informed priors to be equal to or greater than those developed with data-informed priors in 94% of comparisons. Overall, exposures at these facilities are consistent with well-controlled work environments. That is, the 95th percentile of exposure distributions are ≤50% of the occupational exposure limit (OEL) for all chemical-SEG combinations evaluated; and are ≤10% of the limit for 94% of chemical-SEG combinations evaluated.     

Education and safe handling in pesticide application

Summary An International Workshop on Education and Safe Handling in Pesticide Application was organised in Buenos Aires and in San Carlos de Bariloche, Argentina from March 12–18, 1981 by the Scientific Committee on Pesticides of the International Association on Occupational Health.Papers and discussions dealt with the principles and practice of education in safe handling of pesticides. Many papers demonstrated that the vast amounts of pesticides used in developing countries stand in sharp contrast to the poor level of understanding of the potential health hazards involved.Eight recommendations were formulated providing suggestions for improvement of educational programmes and safe handling.The proceedings of this Workshop will be published by Elsevier Scientific Publishing Company in the autumn of 1981     

Views of the dietetics profession on communication skills for behaviour change in dietetics

Background: There is strong evidence to suggest that the communication skills of the practitioner are an important factor in helping people to change health‐related behaviour (Najavits & Weiss, 1994; Stewart et al., 2003). Despite this, many UK dietitians perceive their pre‐registration training in communication skills to be inadequate (Rapoport & Nicholson Perry, 2000). Many new courses have recently been approved by the Health Professions Council, and the British Dietetic Association (BDA) has recently undertaking a curriculum review for dietetic training. This study aimed to explore the current views of the dietetic profession in relation to their training in this area. Methods: A cross sectional survey was completed in October 2007. All BDA members (n = 6013) were sent a questionnaire to ascertain their views on communication skills for behaviour change in dietetic practice and relevant training. The questionnaire had been piloted on dietetic colleagues and comments received from an expert on communication skills for behaviour change. Approval was obtained from the University of Nottingham Medical School Research Ethics Committee. Results: There were 1158 respondents (19% response rate) of whom 418 (36%) had qualified since 2000. All countries within the UK and a wide variety of specialist areas were represented. Some communication skills training had been completed by 89% of respondents. Communication skills were rated as either ‘very’ or ‘extremely’ important by 96% respondents. There was no difference between those who had qualified before the year 2000 and those who had qualified since. Respondents agreed that implementing communication skills had led to improvements in their relationships with patients (70%), job satisfaction (59%) and confidence in client interviews (69%). However, 21% felt time keeping in client interviews was worse. Time was also identified as a barrier to putting learning into practice (19%). The majority of respondents (89%) felt they would benefit from further training. Discussion: The results must be viewed in light of the relatively low response rate. However, respondents clearly endorsed the importance of good communication skills in practice and had personally experienced positive outcomes because of their use. Despite their positive attitude, the practice of good communication was felt to have had a negative effect on time‐keeping. Unsurprisingly, the majority of participants wanted further training. Conclusions: The negative effect of introducing changes of practice to improve communication skills upon time‐keeping was a major concern for BDA members. Further research and training is required to support the implementation of improved communication skills within the recognized time constraints of dietetic practice. References Najavits, L.M. & Weiss, R.D. (1994) Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review. Addiction 89, 679–688. Rapoport, L. & Nicholson Perry, K. (2000) Do dietitians feel they have had adequate training in behaviour change methods. J. Hum. Nutr. Diet. 13, 287–298. Stewart, M. et al. (2003) Patient centred medicine: Transforming the clinical method, 2nd edn. Oxford: Radcliffe Medical Press.     

A survey of dietetic practice in obesity management

Introduction: Little is known about how dietitians organize the management of overweight and obese clients. The aim of this survey was to identify current dietetic practice in the management of such clients. Methods: In preparation for the joint Association for the Study of Obesity/British Dietetic Association (BDA) symposium in November 1997, a questionnaire was sent to BDA members registered on two BDA databases in order to identify current practice in the dietetic management of obesity. A total of 347 BDA members were contacted; 252 dietetic heads of service (or equivalent) and 95 members on the BDA freelance register. Information relating to referral criteria, organizational details and key features of typical management programmes was collected. Results: A poor response rate of 40% was achieved, with a similar response rate from dietetic heads of service and freelance dietitians. Of those who did respond, 91% accepted referrals for overweight or obese clients. The majority of respondents allocated up to 30 min for a new client appointment, and offered at least one follow-up appointment, usually at 4-week intervals and lasting up to 20 min. Freelance respondents allocated longer times for new client and follow-up appointments, and also reviewed patients more frequently (but did not allocate more follow-up appointments), than dietetic heads of service. Most consultations were on an individual basis and were not guided by standardized protocols. Conclusion: There is clearly an opportunity for dietitians to move towards evidence-based treatment of obesity, without substantial resource implications, by offering longer-term treatment using group therapy. The use of clinical guidelines, and auditing future dietetic practice against these guidelines, should be considered.     

Cancer mortality and saccharin consumption in diabetics.

The mortality experience of 5971 members of the British Diabetic Association (BDA) was followed-up for between five and eight years to mid-1973. Overall, 1207 deaths occurred compared with 778 expected from the mortality of the population of England and Wales in 1972. This excess of deaths was due almost entirely to diabetes mellitus and ischaemic heart disease. Deaths from cancer (128) were significantly fewer than expected (168), mainly because of a deficit in the number of deaths from cancers related to smoking (cancers of the buccal cavity and pharynx, oesophagus, respiratory system, and bladder). There was also a lower than expected mortality from chronic bronchitis and emphysema. Data on saccharin consumption by BDA members showed that more than half of them used saccharin tablets daily, with an overall daily intake of three to six tablets, depending on age and sex. Information on a small sample of survivors from the mortality study suggested that about 23% of them would have taken saccharin daily for 10 years or more and 10% for 25 years or more by the end of the follow-up. It was concluded that these relatively high levels of saccharin intake had not increased the risk of cancer in general among BDA members.     

A Scheme of Higher Specialist Training in Surgery

A scheme to assist those who wish to obtain specialist surgical experience and training has been elaborated by the four Royal Colleges of Surgeons in the British Isles, together with the Association of Professors of Surgery and a number of the specialist surgical associations. The reasons for the scheme, the general principles on which it is based, and the details that have so far been agreed are set out below.     

上海市级医院日间化疗管理共识

上海市级医院日间化疗已形成一定规模，但日间化疗流程和制度有待完善。为促进日间化疗发展，上海市医院协会日间手术管理专业委员会日间化疗学组组织专家，结合上海市级医院日间化疗实际，从日间化疗的组织管理模式、设置要求、适应范围、服务流程、医疗质量和安全、信息管理建设等方面，形成了上海市级医院日间化疗管理共识，为进一步制定日间化疗相关政策提供参考。     

Big issues, small systems: managing with information in medical research

This subject of this article is the design of a database system for handling files related to the work of the Molecular Genetics Department of the International Blood Group Reference Laboratory. It examines specialist information needs identified within this organization and it indicates how the design of the Rhesus Information Tracking System was able to meet current needs. Rapid Applications Development prototyping forms the basis of the investigation, linked to interview, questionnaire, and observation techniques in order to establish requirements for interoperability. In particular, the place of this specialist database within the much broader information strategy of the National Blood Service will be examined. This unique situation is analogous to management activities in broader environments and a number of generic issues are highlighted by the research.     

Current practice in the management of children with cerebral palsy: a national survey of paediatric dietitians

Background Dietitians play a key role in the clinical management of children with cerebral palsy. This survey was conducted with the aim of establishing an overview of current dietetic practice in the management of these children. Method A questionnaire which asked for information on aspects of dietetic practice relating to children with cerebral palsy was circulated to members of the British Dietetic Association during May to October 2000. Results Many respondents had a small caseload size. However, a larger caseload was linked to membership of a multi‐disciplinary team, a greater proportion of severely disabled children and use of a wider range of anthropometric measurements. Dietitians who were members of a multi‐disciplinary team were more likely to visit children at home. Conclusions This survey provides an overview of current dietetic practice in the UK regarding the management of children with cerebral palsy. There is a potential shortfall in specialist dietitians and this survey highlights some of the gaps in service provision. Children with cerebral palsy benefit from dietetic input and there is an increasing need for specialist dietitians to be involved in their management. It will be necessary to continue to identify any gaps and find ways to overcome them.     

HEALTH IN PHYSICAL EDUCATION AND ATHLETICS

This section of the Journal is a project of the Committee on The Health Aspects of Physical Education and Athletics. This month's timely question is based on a recommendation that is generally accepted as desirable although questions as to its practicality have been raised. Suggestions for questions to be discussed in future issues, or comments on subjects already discussed will be welcomed.