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  • A Sustainable Dietetics Bridging Program: Development and Implementation in Atlantic Canada
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 2 • pp. 95 - 100
    A provincial focus on immigration and improved foreign credential recognition has led to an investigation of best practices and subsequent recommendations for the development and implementation of a sustainable university-based bridging program for internationally educated dietitians in Atlantic Canada. Data were collected from various sources and used to inform program decisions and direction. An advisory framework was established through a core group representing dietetics education and regulation and internationalization. Subsequently, a key stakeholder group was formed. As a result of this collaboration and research, a dietetics bridging framework was developed and a program pilot tested. Lessons learned may inform similar endeavours and highlight the importance of collaborative leadership and collaboration among multiple stakeholders, and of creatively addressing program sustainability issues while keeping learners (internationally educated dietitians) at the centre.
  • Experiences of People of Acadian Descent Receiving Hemodialysis in Southwest Nova Scotia
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 2 • pp. 342 - 345
    We conducted a group interview with five hemodialysis patients of Acadian descent. Our purpose was to learn about their intakes of Acadian foods so we could tailor our advice for other Acadian patients receiving hemodialysis. This approach builds on evidence that addressing cultural aspects of food choice and aligning dietary recommendations with usual intakes create optimal conditions for diet adherence while preserving personal habits and heritage. In this study, “the Acadian diet” held multiple meanings for different participants, participants varied in their intakes of traditional Acadian foods, intakes of traditional Acadian foods were decreasing in younger generations, and the desire to preserve kidney function had priority over eating much-loved traditional foods. These findings support the practices of individualized nutritional and dialysis care and discourage generalized nutrition messages based on assumptions of homogeneity of all people within a cultural group.
  • Promoting Nutritional Well-being in Seniors: Feasibility Study of a Nutrition Information Series
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 4 • pp. 175 - 180
    Better Living Health and Community Services developed a 12-week community-based nutrition information series (NIS) for people aged 55 or older. The purpose of this feasibility study was to describe briefly the process of developing and implementing the 12-week NIS and to identify the practicality and plausibility of the program in terms of its process and content attributes, using Thorncliffe Park community as the test site. A pre- and post-test design was used to identify changes in participants’ perception of their nutritional and overall well-being. Twenty-four participants who completed at least four sessions participated in the post-evaluation follow-up. Only participants’ perception of their eating habits demonstrated a significant, positive improvement (t24=2.1, P<0.05). The results suggest that the NIS has the potential to promote the health and well-being of community-living seniors. The development and implementation of the NIS provided considerations for program practicality. However, additional work is needed to examine the plausibility of the program in meeting its stated objective to promote awareness of nutrition as an important concept for healthy aging. Community-practising dietitians are instrumental in providing credible nutrition information to facilitate healthy eating in older Canadians.
  • A Study of Challenges and Opportunities: For Long-term Care Dietitians in British Columbia
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 3 • pp. 131 - 137
    While demand for long-term care (LTC) in Canada is expected to grow in the coming years, little is known about the current LTC dietetic workforce or its members’ practice-related concerns. A web-based survey was developed and distributed to and subsequently completed by 75 LTC dietitians in British Columbia. The survey was intended to characterize dietitians’ demographic characteristics, educational and employment experiences, salaries and benefits, future employment plans, and concerns about current practice. Regression models were used to examine the associations between demographic, educational, and employment characteristics and self-reported hourly wages. The majority of respondents were employed at more than one facility (57%) and did not belong to a union (71%). The mean hourly wage for LTC dietetics positions was $37.50 ± $5.85, and was significantly higher for positions that did not provide additional employee benefits (p<0.05). Hourly wages were not significantly higher for dietitians with more years of experience or graduate-level education. Concerns were raised about potential implications of revised residential care regulations for workload, and only 36% of respondents reported being committed to working in the area of LTC dietetics in the future. This study highlights practice-related challenges and future opportunities to build the LTC dietetic workforce, and can inform planning for training, recruitment, and retention.
  • Dietary Patterns of Female University Students: With Nutrition Education
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 3 • pp. 138 - 142
    Dietary patterns were examined in a convenience sample of 36 female University of Alberta students, all of whom had completed at least one nutrition course. Data from a validated food frequency questionnaire were used to determine if students had a dietary pattern similar to that recommended in Eating Well with Canada's Food Guide (EWCFG) or by the Traditional Healthy Mediterranean Diet Pyramid (THMDP), as measured using a Mediterranean Diet Quality Index Score. No student consumed the THMDP minimum number of portions of legumes, seeds, and nuts, of olive oil, or of whole grains. The majority did not meet the minimum EWCFG recommendations for any food group. The results suggest that nutrition education alone may be insufficient to ensure optimal dietary patterns among female university students. The methodology reported in this study is novel in assessing whether dietary patterns resemble the THMDP or the EWCFG.
  • Sarcopenia and Physical Function: In Overweight Patients with Advanced Cancer
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 69 - 74
    Advanced cancer is associated with numerous metabolic abnormalities that may lead to significant body composition changes, particularly muscle loss or sarcopenia. Sarcopenia in cancer has been associated with poor clinical outcomes, including poor physical function. Accurate tools to assess body composition are expensive and not readily available in clinical settings. Unfortunately, little is known about the efficacy of affordable and portable techniques to assess functional status in patients with cancer. We investigated the prevalence of sarcopenia and its association with different portable and low-cost functional status measurement tools (i.e., handgrip strength testing, a two-minute walking test, and a self-report questionnaire) in overweight/obese patients (body mass index ≥ 25 kg/m2) with advanced cancer. Twenty-eight patients (68% men) aged 64.5 ± 9.5 years with advanced lung or colorectal cancer were included. Sarcopenia was assessed by measuring appendicular skeletal muscle (ASM) adjusted by height (ASM index), using dual energy X-ray absorptiometry. Approximately 36% of patients had sarcopenia. Average handgrip strength was greater in men without sarcopenia than in men with it (p=0.035). In men, ASM index was positively correlated with average (r=0.535, p=0.018) and peak handgrip strength (r=0.457, p=0.049). No differences were observed among female patients. Handgrip strength was associated with sarcopenia in male patients with advanced cancer, and therefore it may be used as a portable and simple nutritional screening tool.
  • Role of the Nutrition Professional: In High-risk Obstetrics Inpatient Teams
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 75 - 79
    Beyond the management of gestational diabetes and weight control, limited literature exists on nutritional management in high-risk pregnancies. This study is a starting point for understanding the role of the registered dietitian (RD) in high-risk obstetrics (HRO) inpatient teams. Demographic information was gathered on Ontario HRO inpatient units and patient characteristics, and the RD’s role in this setting was explored. Representatives from all six HRO units in Ontario completed a questionnaire. Five of the HRO units had an RD on the team. The RDs stated that their primary role in the unit involved providing nutrition education and support, screening patients for nutritional risk, and writing vitamin and mineral orders. This was the first study in which RDs’ role in HRO inpatient units was examined. Existing literature supports the role of good nutrition in preventing and treating the conditions seen in HRO units; however, RDs’ specific role remains unclear. Future studies are needed to analyze the effect of nutrition on these HRO conditions, and to support the development of best practice guidelines.
  • The Role of Registered Dietitians: In Health Promotion
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 80 - 83
    We used our experience assisting in the development of and evaluating the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a basis for exploring roles that registered dietitians (RDs) can play within health promotion, and how others perceive the RD role. Data were generated via 12 key informant interviews and observations during a multiple case study of recreation facilities that had and had not adopted the ANGCY. We also drew on dialogue and personal observations during development of the ANGCY. Dietitians working in government, academia, community settings, private practice, and industry played an important role throughout the development and implementation of the ANGCY. Some sectors proactively sought RD expertise, while others with less ability to pay accessed RDs’ services less. Informants generally regarded RDs in a positive light. Findings indicate the profession should incrementally adjust training models to reflect emerging areas of practice, and highlight the need for RDs to proactively seek new avenues in which to apply their skills. These actions will help RDs remain the trusted source of food and nutrition information, not only in health care, but also within health promotion settings.
  • Promoting eHealth Literacy in Older Adults: Key Informant Perspectives
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 1 • pp. 37 - 41
    Health literacy has the potential to improve an individual’s capacity to access, understand, evaluate, and communicate basic health information and services in order to make appropriate health decisions. We developed a research agenda to help older adults become aware of health literacy and its function in promoting their nutritional health and well-being. A key activity is the development, implementation, and evaluation of an eHealth literacy tool, eSEARCH, targeted at older adults to help improve their eHealth literacy skills. Before consultations were held with this subpopulation to assess their eHealth literacy needs and abilities, key informant interviews were conducted with eight experts in the field of health literacy, the older adult population, and/or online communications. Some experts were identified from the relevant literature; others were identified by informants who had already been interviewed. Informants were asked nine questions about the perceived importance of health literacy in Canada, key considerations in developing an eHealth literacy tool, and supporting resources for advancement of the eHealth literacy tool. Informants agreed that health literacy is a key concept and stressed that key considerations for development of the eSEARCH tool are identifying the target population’s needs, focusing on health promotion, and increasing confidence in information-seeking behaviours. Identified challenges are ensuring accessibility, applicability to older adults, and adoption of the tool by dietetic and other health care professionals.
  • A Participatory Food Costing Model: In Nova Scotia
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. 181 - 188
    In recognition of the growing challenge that food insecurity has on population health, a multisectoral partership in Nova Scotia has been working since 2001 to address province-wide accessibility to a nutritious diet. The participatory food costing (PFC) model has been at the forefront of provincial and national efforts to address food insecurity; a local foods component was incorporated in 2004. This model has engaged community partners, including those affected by food insecurity, in all stages of the research, thereby building capacity at multiple levels to influence policy change and food systems redesign. By putting principles of participatory action research into practice, dietitians have contributed their technical, research, and facilitation expertise to support capacity building among the partners. The PFC model has provided people experiencing food insecurity with a mechanism for sharing their voices. By valuing different ways of knowing, the model has faciliated muchneeded dialogue on the broad and interrelated determinants of food security and mobilized knowledge that reflects these perspectives. The development of the model is described, as are lessons learned from a decade of highly productive research and knowledge mobilization that have increased stakeholders’ understanding of and involvement in addressing the many facets of food security in Nova Scotia.
  • Referral Criteria for Assessment and Treatment: In an Ambulatory Dysphagia Clinic
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. 189 - 194
    Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient’s sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m2 ± 6.7 kg/m2, respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia.
  • Dietary Patterns of Patients: With Advanced Lung or Colorectal Cancer
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. e298 - e303
    The purpose of this study was to identify dietary patterns among patients with advanced cancer. Differences between cancer groups are described, and food groups contributing higher proportions to overall caloric intake are identified. Patients with advanced cancer (n=51) were recruited from a regional cancer centre and completed a three-day dietary record. Food items were categorized according to macronutrient content. After adjustment for body weight, substantial variation in energy intake was observed (range: 13.7 to 55.4 kcal/kg/day). For 49% of patients, protein intake was below recommendations. Overall, patients consumed the largest proportion of their calories from meat (16%), other foods (11%), dessert (9%), fruit (9%), white bread (7%), and milk (7%). Only 5% of patients consumed meal replacement supplements. The results of this descriptive study provide important insights into the dietary habits of patients with advanced cancer. These insights could be translated into the development of effective recommendations for maintaining or improving health and quality of life.
  • Dietitians and Eating Disorders: An International Issue
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 2 • pp. 86 - 90
    The prevalence of eating disorders is higher in university nutrition faculties than in other faculties. We examined beliefs about and approaches to eating disorders in nutrition education faculties around the world. We developed a questionnaire specifically for this project and distributed 664 copies electronically, using contact information obtained in collaboration with Dietitians of Canada and the International Confederation of Dietetic Associations. Using the 101 questionnaires returned from 14 countries, we found that 77% of respondents felt eating disorders are a concern among nutrition students; however, only 15% of programs had policies/procedures to help address these disorders. Forty-eight percent of respondents thought screening for eating disorders would be a good idea; however, 78% of them believed screening would involve ethical issues. In conclusion, eating disorders are a concern in nutrition faculties around the world, and while most feel something should be done, ethical dilemmas contribute to confusion over the best approach. More work is needed in this area.
  • A Team-based Approach to Qualitative Inquiry: The Collaborative Retreat
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 2 • pp. 91 - 97
    A team of researchers undertook a collaborative qualitative study to explore beginning dietitians’ life experiences and the meaning ascribed to those experiences in the context of dietetic practice. Data were collected using Seidman's three-step in-depth phenomenological interviewing method with 12 beginning dietitians who were graduates of the three participating dietetic programs. We outline the collaborative research process and highlight a writing and data analysis technique described as the collaborative retreat, a face-to-face, two-day gathering that facilitated the researchers’ collective decision-making and organization, discussion, and analysis of this complex qualitative data set. Use of a listening guide aided researchers’ understanding and interpretation of participant voices. Researchers concluded that the overall collaborative qualitative research process was positive and self-fulfilling, and that it resulted in multiple benefits for them individually and the research project collectively. Researchers were able to work through methodological and theoretical issues as these arose, with the assistance of technology, writing, listening, and dialogue. Relationship building and relationship maintenance emerged as factors critical to the success of the research process. Collaborative research teams that are committed to listening, writing, and dialogue will find that the collaborative retreat can be a productive site of knowledge generation and mentorship.
  • Regulatory Approval of Plant Sterols in Canada: Implications for Health Care and Clinical Practice
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. 31 - 34
    Health Canada’s recent approval of plant sterols as food ingredients to decrease low-density lipoprotein cholesterol (LDL-C) is believed to be a significant step toward improving Canadians’ cardiovascular health and reducing the economic burden of heart disease. When dyslipidemic patients consume plant sterols at a recommended daily dose of 2 g, they can reduce LDL-C by 10% to 15%, with no deleterious effects on high-density lipoprotein cholesterol. A 10% LDL-C reduction in response to plant sterol consumption is projected to reduce heart disease risk by 25%. Because they are available without a prescription, plant sterols are an option for dietitians who wish to provide cholesterol-lowering guidance beyond traditional dietary advice (i.e., lowering saturated fat intake and restricting dietary cholesterol). In addition, plant sterols can be used in combination with a statin or when statin use is contraindicated, and they have recently emerged as a potentially valuable triglyceride-lowering option. However, the projected improvement in public health and health care savings will be realized only if impediments to daily use are removed. One such impediment is the higher cost of fortified food products, such as yogurt and margarine. If the cost of plant sterol food products is to decline, cost-effective sources must be investigated and a larger range of foods containing plant sterols must be made available.
  • Availability of Nutrition Screening Parameters: In New Brunswick Hospitals and Nursing Homes
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. 35 - 39
    We explored the availability of parameters for a nutrition screening system among elderly people in New Brunswick (NB) health care facilities. Patients aged 65 or older were asked to participate in the study; each participant had been admitted to one of four hospitals or lived in one of six nursing homes. Availability of nutrition screening parameters (weight, height, weight change, serum albumin level, appetite, and food intake record) was assessed by auditing the participants’ medical charts. When data were not available, the feasibility of obtaining them was determined. Additional data related to nutrition screening were also obtained. In total, 421 participants were recruited for the study: 140 (33.2%) who lived in nursing homes and 281 (66.8%) who were in hospitals. Parameters needed to conduct nutrition screening, such as weight upon admission, were available for 83.6% of participants; usual weight was available for 43.0%, height for 86.0%, and serum albumin level for 47.5%. Our findings show that basic parameters for nutrition screening are available, and that implementation of a nutrition screening system is feasible for patients in NB health care facilities.
  • Employers’ Perspectives of Students: In a Master of Public Health (Nutrition) Program
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. e221 - e226
    Efforts to support workforce development led to the launch of a new master of public health program aimed at improving access to graduate studies for practising nutrition professionals. The first cohort of students identified employer support as a key determinant of their success. In order to identify ways of addressing both student and employer needs, we explored the perspectives of students’ employers. Seventeen in-depth, semi-structured, open-ended interviews were conducted with employers. Interviews were audiotaped and transcribed. Transcripts were organized using NVivo software and coded thematically. All employers indicated support for employee education and development in principle, but most faced practical challenges related to limited staffing during education leaves. Organizational policies varied considerably across employer groups. Collective agreements that guided education policy were seen to ensure consistent support for employees, but also to limit creative approaches to education support in some situations. Employers highly valued graduate student projects that were directly related to the workplace; these projects presented opportunities for collaboration among the university, students, and employers. Universities need to work with employers and other stakeholders to identify ways of overcoming barriers to public health nutrition graduate education and workforce development.
  • Implementing Nutrition Diagnosis: At a Multisite Health Care Organization
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 178 - 180
    The American Dietetic Association Nutrition Care Process (NCP) is designed to improve patient care and interdisciplinary communication through the consistent use of standardized nutrition language. Supported by Dietitians of Canada, the NCP has been gaining prominence across Canada. In spring 2009, registered dietitians at Providence Health Care, an academic, multisite health care organization in Vancouver, British Columbia, began using the NCP with a focus on nutrition diagnosis. The success of nutrition diagnosis at Providence Health Care has depended on support from the Clinical Nutrition Department leadership, commitment from the NCP champions, regularly scheduled lunch-and-learn sessions, revised nutrition assessment forms with a section for nutrition diagnosis statements, and the Pocket Guide for International Dietetics & Nutrition Terminology (IDNT) Reference Manual. Audit results from June through August 2010 showed a 92% nutrition diagnosis completion rate for acute-care and long-term care sites within Providence Health Care. Ongoing audits will be used to evaluate the accuracy and quality of nutrition diagnosis statements. This evaluation will allow Providence Health Care dietitians to move forward with nutrition intervention.
  • Weight Maintenance Through Behaviour Modification: With a Cooking Course or Neurolinguistic Programming
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 181 - 185
    We compared the effect on weight regain of behaviour modification consisting of either a gourmet cooking course or neurolinguistic programming (NLP) therapy. Fifty-six overweight and obese subjects participated. The first step was a 12-week weight loss program. Participants achieving at least 8% weight loss were randomized to five months of either NLP therapy or a course in gourmet cooking. Follow-up occurred after two and three years. Forty-nine participants lost at least 8% of their initial body weight and were randomized to the next step. The NLP group lost an additional 1.8 kg and the cooking group lost 0.2 kg during the five months of weight maintenance (NS). The dropout rate in the cooking group was 4%, compared with 26% in the NLP group (p=0.04). There was no difference in weight maintenance after two and three years of follow-up. In conclusion, weight loss in overweight and obese participants was maintained equally efficiently with a healthy cooking course or NLP therapy, but the dropout rate was lower during the active cooking treatment.
  • Developing an Interview Guide to Evaluate Practice-based Evidence in Nutrition: Use of the Delphi Technique
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 186 - 190
    An interview guide was created for qualitative evaluation of the impact of Practice-based Evidence in Nutrition (PEN) on dietetic practice, and its success as a medium for knowledge translation and transfer (KTT). The Delphi technique was used to bring together a diverse group of experts (n=7) with extensive knowledge in KTT and evidence-based practice (EBP); these experts developed the interview guide content. The technique is an effective means of gathering expert input to inform evaluation tool development, particularly in the absence of accepted evaluation guidelines or pre-existing evaluation tools. Although challenges exist with the Delphi technique, it is an adaptable method that can be modified to meet a variety of needs. During this project, the technique was modified to meet specific needs, including participants’ partial anonymity and starting material to reduce the number of required rounds. The resulting interview guide contained open-ended questions focused on respondents’ understanding of EBP and PEN, use of PEN by dietitians in other disciplines, perceptions of the quality/usefulness of PEN, and barriers to and facilitators of PEN use.
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