Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,Proficient, and Expert) in Clinical Nutrition Management

Clinical nutrition management (CNM) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for clinical nutrition services within an organization. Although RDNs in CNM are typically employed in acute care, they are also employed in settings where management of nutrition services is required, such as foodservice departments, ambulatory clinics, telehealth services, public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty departments, for example, dialysis units or cancer centers. RDNs in CNM aim to create work environments that support high-quality customer-centered care, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The CNM Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in CNM for three levels of practice: competent, proficient, and expert. The SOPP describes six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in CNM are written with the leader in mind—to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.     

Hemiarthroplasty Conversion: A Comparison to Primary and Revision Total Hip Arthroplasty

BackgroundArthroplasty is the standard of care for elderly patients with displaced femoral neck fractures, with viable options including hemiarthroplasty (HA) and total hip arthroplasty (THA). With time, HA may need to be converted to THA, but it is unclear whether this is more similar to primary or revision THA. We compare complication and revision rates between these groups within 90 days and 2 years postoperatively.MethodsWe retrospectively reviewed 3 cohorts of patients treated at our institution: primary, conversion, and revision THA. Outcomes studied included intraoperative data, postoperative complications, and revision rates. We analyzed the groups using both parametric (analysis of variance test) and nonparametric (chi-squared test) statistics.ResultsOperative time between primary THA (108.0 minutes), conversion HA (147.9 minutes), and revision THA (160.1 minutes) cohorts differed significantly (P = .011). Estimated blood loss was also different between primary THA (386 mL), conversion HA (587 mL), and revision THA cohorts (529 mL) (P = .011). At 2 years, major complication rates between primary THA (6.2%), conversion HA (11.7%), and revision THA (26.7%) cohorts also differed significantly (P = .003), as was the revision rate in the primary THA (4.6%), conversion HA (10.0%), and revision THA (18.3%) cohorts (P = .043).ConclusionThis is the first study to compare short-term and midterm complications between primary, conversion, and revision THA. We observed conversion HA had similar operative time and estimated blood loss to revision THA, which was significantly higher than primary THA. However, we found that conversion HA more closely resembled primary THA with respect to perioperative complications rates.