Using risk of bias domains to identify opportunities for improvement in food- and nutrition-related research: An evaluation of research type and design, year of publication, and source of funding.

PURPOSE: This retrospective cross-sectional study aimed to identify opportunities for improvement in food and nutrition research by examining risk of bias (ROB) domains. METHODS: Ratings were extracted from critical appraisal records for 5675 studies used in systematic reviews conducted by three organizations. Variables were as follows: ROB domains defined by the Cochrane Collaboration (Selection, Performance, Detection, Attrition, and Reporting), publication year, research type (intervention or observation) and specific design, funder, and overall quality rating (positive, neutral, or negative). Appraisal instrument questions were mapped to ROB domains. The kappa statistic was used to determine consistency when multiple ROB ratings were available. Binary logistic regression and multinomial logistic regression were used to predict overall quality and ROB domains. FINDINGS: Studies represented a wide variety of research topics (clinical nutrition, food safety, dietary patterns, and dietary supplements) among 15 different research designs with a balance of intervention (49%) and observation (51%) types, published between 1930 and 2015 (64% between 2000-2009). Duplicate ratings (10%) were consistent (κ = 0.86-0.94). Selection and Performance domain criteria were least likely to be met (57.9% to 60.1%). Selection, Detection, and Performance ROB ratings predicted neutral or negative quality compared to positive quality (p<0.001). Funder, year, and research design were significant predictors of ROB. Some sources of funding predicted increased ROB (p<0.001) for Selection (interventional: industry only and none/not reported; observational: other only and none/not reported) and Reporting (observational: university only and other only). Reduced ROB was predicted by combined and other-only funding for intervention research (p<0.005). Performance ROB domain ratings started significantly improving in 2000; others improved after 1990 (p<0.001). Research designs with higher ROB were nonrandomized intervention and time series designs compared to RCT and prospective cohort designs respectively (p<0.001). CONCLUSIONS: Opportunities for improvement in food and nutrition research are in the Selection, Performance, and Detection ROB domains.

Quality delegation grid: a decision tool for evaluating delegation of management tasks in hospital dietetics departments.

This research was designed to determine perceptions of the quality of task performance; identify personnel currently performing selected management and food production tasks in a hospital dietetics department; and develop a grid for examining delegation strategies. Information on task quality and delegation was obtained from 309 dietitians and 208 support personnel in 151 hospitals. This information was used to develop a quality delegation grid. The grid is divided into four quadrants: High Quality/High Delegation; High Quality/Low Delegation; Low Quality/High Delegation; and Low Quality/Low Delegation. The grid was used to evaluate the delegation of management tasks reported by participants in this study. Our results indicated that the majority of tasks were placed in the High Quality/High Delegation quadrant (28 tasks) and the Low Quality/Low Delegation quadrant (17 tasks), suggesting that delegation was appropriate for the quality expected if the task was delegated. Three tasks were placed in the Low Quality/High Delegation quadrant indicating that tasks were delegated even though quality of the completed task was perceived as low when delegated, suggesting that dietitians should have performed these tasks themselves. Four tasks were placed in the High Quality/Low Delegation quadrant indicating that dietitians were performing tasks that were perceived to have high quality when performed by support personnel, yet these tasks were rarely delegated. Foodservice directors could use the grid to identify training needs, differentiate perceptions between dietitians and support personnel, and evaluate current delegation patterns.

Individualized menu slips improve the accuracy of patient food trays.

We evaluated the effect of five menu slip formats on worker preference and accuracy of food trays in a simulated hospital tray line. Menu slip formats were either individualized or preprinted, and various combinations of color coding, large type, and bold print were used to code the type of diet and the menu choices to be placed on the tray. Student volunteers who had not worked in hospital foodservice were used as tray line workers to reduce the possibility of prior preference for a menu slip format. Results indicate that menu slip format significantly affects both worker preference and the accuracy of assembled food trays. Errors were significantly lower with individualized formats that identified menu selections in bold print and type of diet in either large type or colored ink. The highest error rate was found with preprinted formats. An individualized menu slip that identified menu selections and diet orders with large type and bold print received the highest worker preference rating and resulted in the most accurate tray assembly.

Activities of coordinated dietetic program directors compared by educational background.

This study was designed to ascertain the activities performed by coordinated program directors, compare current activities with 5-year expectations, and identify differences in importance and time spent on 14 pertinent activities by directors with master's degrees and those with doctorates. Responses were collected by a descriptive survey of 64 directors, all of whom participated. Program directors with master's degrees considered public relations with affiliations, attending faculty meetings, student advisement, and reading professional materials significantly more important (p less than .05) than did directors with doctorates, who considered faculty evaluations and research significantly more important (p less than .01). Directors with doctorates spent significantly less time in teaching (p less than .05) than those with master's degrees. Responsibilities of directors in the 22 submitted descriptions were organized into five categories: program management, curricular affairs, policies impacting on programs, student advisement and counseling, and academic activities. In the ADA Standards of Education, responsibilities of directors include program assessment, planning, and evaluation; in this study, those responsibilities were placed in the program management category. Exhibition of leadership qualities, revision of curriculum, and counseling and recruitment of students were responsibilities most frequently included in the position descriptions; however, those responsibilities were in categories other than program management. The responsibilities could serve as a guide for the development of a position description and as criteria for the role of a coordinated program director.