Nutrition assessment in process-driven, personalized dietetic intervention - The potential importance of assessing behavioural components to improve behavioural change: Results of the EU-funded IMPECD project.

BACKGROUND & AIMS: Although up-to-date definitions for nutrition assessment integrate behavioural components, it is not clear what behavioural components are to be assessed. Since behavioural modification is linked to effective therapeutic dietetic interventions, assessing behaviour and factors influencing behaviour might be beneficial to improve personalized dietetic outcome. The aim of the following report is to emphasize the role of behavioural components and factors affecting behaviour at baseline nutrition assessment in personalized dietetic intervention. METHODS: The present work is part of the EU-funded project IMPECD ("Improvement of Education and Competences in Dietetics", www.impecd.eu). The project aims to improve the clarity and consistency of national dietetic process models to unify education and training of future dietitians. Experts from five European Universities of Applied Sciences (UAS) in Antwerp (BE), Fulda (DE), Groningen (NL), Neubrandenburg (DE) and St. Pölten (AT) developed a Massive Open Online Course (MOOC) consisting of several clinical cases. It warranted a detailed evaluation of all dietetic care process steps, starting with nutrition assessment. RESULTS: Results for motivation assessed during nutrition assessment are not consistently positively associated with outcome and the added value of assessing them at baseline is still unclear. However, depressive symptoms, emotional distress, and anxiety negatively affect eating and physical activity and therefore limit the efficacy of the dietetic intervention. Assessing behavioural components including nutrition literacy is an important precondition for influence on behavioural modification. CONCLUSION: Indisputably, baseline assessment of behavioural components and factors influencing behaviour are important to increase the therapeutic efficacy of personalized dietetic interventions.

Hoarding among Jewish Holocaust Survivors: Moving Toward a Theoretical Model.

BACKGROUND: Previously described as a subcategory of obsessive compulsive disorder (OCD), hoarding disorder was added to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a stand-alone diagnosis for the first time. The first formal research in the 1990s surprisingly found no connection between material deprivation early in life and hoarding; however, later studies linked early traumatic life experiences with hoarding. Subsequent familial studies demonstrated a genetic predisposition for hoarding. Emerging evidence suggests a link between a post-traumatic stress disorder (PTSD) and hoarding in Jewish Holocaust survivors. OBJECTIVES: To evaluate the literature on PTSD among Jewish Holocaust survivors for associations between PTSD and hoarding. METHODS: A systematic search of selected databases, including PubMed, Google Scholar, NCBI, Psych Info, and EBSCO Host was conducted from 1 March 2017 to 15 July 2018 using the following search terms: hoarding, hoarding disorder, obsessive compulsive disorder, OCD, compulsive hoarding, Jewish Holocaust survivors, Shoa, post-traumatic stress disorder, and PTSD. Inclusion criteria included peer reviewed research published on adults in English since 1990. Because no publications linking hoarding and PTSD in Jewish Holocaust survivors were found, references in retained papers were also searched for any relevant published work. RESULTS: Seven articles linking PTSD and hoarding were identified for this review. However, no articles were found linking PTSD and hoarding in Jewish Holocaust survivors. CONCLUSIONS: A relationship between PTSD and hoarding in Jewish Holocaust survivors is conceivable and should be explored to effectively diagnose and care for affected individuals.

Online training introduces a novel approach to the Dietetic Care Process documentation.

AIM: Nutrition professionals in Israel are developing a system to document the Dietetic Care Process (DCP) tailored for specific patient sectors and compliant with national health guidelines. The ultimate goal is to achieve uniform documentation and improve nutrition care. Israeli dietetic practitioners work in specific patient sectors; therefore, a patient population-specific reporting system is proposed instead of the typical singular format applied across all patient populations. The purpose of this project was to evaluate learning outcomes and attitudes among registered dietitians (RDs) after online training of a novel DCP documentation system. METHODS: A total of 80 Israeli RDs working in geriatric practice completed an eight-week online educational program learning documentation that is compatible for use with electronic health records and compliant with Israeli standards of practice. A paired sample t-test and McNemar test were used to analyse pre- to post-test performance, while Pearson's r, point-biserial, Spearman's and ANOVA were used to assess relationships among variables. RESULTS: Post-test knowledge scores increased significantly, t (67) = -9.007, P = 0.000; 95% CI (-26.713, -17.019). Age, education, geographic location and previous experience with online courses were not correlated with academic performance, suggesting that demographic characteristics did not impact training. Overall, RDs (>80%) responded positively to the training model and were highly interested in future proficiency online learning opportunities (98%). CONCLUSIONS: A sectoral DCP online training program significantly improved knowledge and was rated favourably by Israeli RDs. DCP training for clinical practitioners may be optimised when standardised nutrition care and reporting systems are adapted to specific patient populations.

A New System of Documentation to Improve Dietitian-Physician Crosstalk.

BACKGROUND: Standardization of the dietetic care process allows for early identification of malnutrition and metabolic disorders, interdisciplinary collaboration among the medical team, and improved quality of patient care. Globally, dietitians are adopting a nutrition care model that integrates national regulations with professional scope of practice. Currently, Israel lacks a standardized dietetic care process and documentation terminology. OBJECTIVES: To assess the utilization of a novel sectoral documentation system for nutrition care in Israel. METHODS: Seventy dietitians working in 63 geriatric facilities completed an online training program presenting the proposed patient-sectoral-model. Training was followed by submission of sample case studies from clinical practice or completion of a case simulation. Application of the proposed model was assessed by measuring the frequency participants implemented different sections of the model and responses to an approval questionnaire. RESULTS: Fifty-four participants (77%) provided completed cases. Over 80% of participants reported each step of the proposed dietary care process with 100% reporting the "nutrition diagnosis". Fifty-one dietitians (72.8%) completed the approval survey with the section on nutrition diagnosis receiving a highly favorable response (95%), indicating that the new documentation system was beneficial. Over 80% of participants rated the model useful in clinical practice. CONCLUSIONS: A sectoral approach for documenting dietetic care may be the ideal model for dietitians working in specific patient populations with the potential for improving interdisciplinary collaboration in patient care.