PEN eNews 2(1) June 2012

What is your image?

Professional image, that is. With the growth and expansion of electronic communications, we have seen people with diverse backgrounds, develop their authority as a nutrition “expert”. In the last few months, there has been media interest in raspberry ketones, using gluten free diets for weight loss, and the first Global Food Revolution Day. As the most credible source for evidence-based nutrition information, dietitians need to be a part of these “conversations”, wherever they happen.

Dietitians are leaders in promoting health through food and nutrition. How do we as dietitians differentiate ourselves as the go-to-profession for answers on nutrition-related questions? How do we help separate fact from fiction? If we agree or disagree with something, what is the evidence or critical thought that contributes to our opinion? These are questions that we need to ponder as they are related to our professional image. We have a PEN cloud that highlights key attributes of what we are about. How about you - what is your cloud? How do you differentiate yourself?

In PEN eNews 2(1), we have articles to contribute to your professional image. Conference reporting in 2012 – the ways they are a changin’ highlights how to use social media for conference reporting. Are you engaged in social media? We begin a new series Social Media: Dialling into the Digital Age, Part I, offering tips for engaging in social media professionally. Systematic reviews are one tool to help separate fact from fiction. Taking a Balanced Look at Systematic Reviews – Part 2: Flaws in the Diamonds – What are the limitations of systematic reviews? This is the second article in a 2-part series. Wondering how to make sense of the many tools and resources in PEN? Read on! We hope you enjoy PEN eNews 2(1).

Kristyn Hall MSc, RD

Editor, PEN eNews

PENeNews may contain links to other external websites. Dietitians of Canada, The British Dietetic Association, the Dietitians Association of Australia and Dietitians of New Zealand are not responsible for the privacy practices or the content of such external websites and do not endorse the content, products or services on other websites.

What's New in PEN

Wondering what is new in PEN? Here is a list of our updated content in PEN, including updated knowledge pathways, new practice questions, updated practice questions, new professional tools, updated professional tools, and new handouts available.

Updated Knowledge Pathways

New Practice Questions

Updated Practice Questions

New Professional Tools

Metabolic Syndrome Background
Phytate Background
Coconut Water Background
Household Food Insecurity in Canada in 2007-2008 English F rench
Management of Obesity: National Clinical Guidelines (UK)

Updated Professional Tools

New Handouts Available

Healthy Eating While Breastfeeding - The Basics English French
Feeding a Healthy Toddler (12 to 36 months) English French
Low Iodine Diet
Healthy Waists
How to Use Fruits and Vegetables to Manage Your Weight
Healthy Weight Action Plan (Canada)

Knowledge Creation

Using PEN Evidence to Bust Nutrition Myths

In many parts of the world, the heat of the summer is upon us, which naturally raises questions on the best way to stay hydrated. What a perfect time to use our evidence analysis approach to evaluate beverages for their ability to keep us hydrated and bust some nutrition myths.

Myth or Fact? Everyone needs to drink eight glass of plain water every day.

Myth! Plain water has always provided hydration for humans. But what is less clear is how much we need each day. As with many things, there is no one size fits all approach. How much water each individual needs every day varies between and within individuals. For some eight glasses is just right, for others it isn’t. Regardless of how much water we each need every day, it does not have to come only from plain drinking water. Other beverages count. Many fruit juices are over 87% water. Tea and coffee are over 99% water and they don’t dehydrate you like once believed. For more information on hydration see: What is the evidence to support that healthy adults should drink eight 8-oz (250 mL) glasses of water daily for good health?

Myth of Fact? Coconut Water is the better choice than sports drinks for athletes during training and competition.

Myth! Coconut water is 96% water and so, like many beverages, can contribute to our daily fluid needs. Like sports drinks, coconut water also contains carbohydrate and a variety of electrolytes. While sports drinks and coconut water have not been directly compared in published trials for their efficacy during exercise, they usually contain less (and highly variable levels of) carbohydrate and sodium than is optimal for athletes during exercise. However, during rehydration (post-exercise) coconut water and sports drinks were found to be similarly effective when directly compared. After exercise, consuming plain water and food (particularly sodium-containing food) will help promote fluid intake and fluid retention thereby rehydrating the athlete. For more information see: Is coconut water a safe and effective oral rehydration solution for exercise?

Whether it is summer or winter where you are, keep hydration in mind, especially for more active individuals. Have other myths that need busting? Email us at enews@pennutrition.com

Written by Heather Petrie MSc, RD Evidence Analyst Contractor

Written by Kerri Staden, BSc, RD and Jane Bellman, MEd, RD PEN Resource Managers

How do I…. Make sense of the many tools and resources in PEN?

What resources does PEN have for the dietitian/health professional? Where can you find resources in PEN to give to your clients? This month, Lisa has invited Kerri Staden BSc RD and Jane Bellman MEd, RD, PEN Resource Managers to write about making sense of the different tools and resources in PEN.

Backgrounder, Practice Guidance Summary, Related Tools & Resources, Client Materials: There are a variety of tools and resources on nutrition-related topics in PEN. There are tools and resources for:

the dietitian/health professional so they can review evidence and current dietetic practice; and
for distribution to clients.

What resources will I find for the dietitian/health professional?

Background - The best place to find an overview of a topic to complement the questions in PEN is in a Background. The Background will provide basic information on the topic area, as well it contains:

Key Resources for Professionals - specific resources that expand on the Background information and provide further detail on the subject. For example, in the Hypertension Knowledge Pathway, a professional course link to Sodium 101 by the Canadian Stroke Association is provided.
Additional Resources for Professionals - more specific subtopic areas within the subject topic. For example, in the Hypertension Knowledge Pathway, more information on drug-nutrient interactions of herbal preparations and antihypertensive medications is found.

Practice Guidance Summary - This is a summary of key practice points, a basic guide, to the evidence on the Knowledge Pathway topic that the busy practitioner can review to understand the latest evidence for practice related to nutrition. The Practice Guidance Summary contains two sections related to client tools and resources:

Food Lists
Client Handouts
These handouts or fact sheets can be provided to clients and are based on the specific knowledge pathway content. The handouts tend to be PEN developed handouts, with a wider variety available in the Related Tools & Resources section. For example in the Hypertension Knowledge pathway example, the Food List section contains a handout on Low Sodium (Salt) Food Choices and in the Client Handouts section is a handout on Low Sodium (Salt) Cooking, both of which can be copied, distributed, even emailed to clients because they are PEN developed resources [provided you have a PEN license to do so]. Refer to PEN Insider Issue 5 February 2012: How Do I.... Customize PEN Client Handouts for more information.

Related Tools and Resources - This section provides all the tools and resources specific to the knowledge pathway topic, both handouts/fact sheets for clients and information for you as a professional.

Backgrounds, Practice Guidance Summaries and Related Tools and Resources can be found on all pages of each the Knowledge Pathway. They are tabs that appear on the right hand side of the page.

Where on PEN can I find resources to give to my clients?

PEN offers a variety of client handouts/factsheets, specific to a diet or nutrition topic. These handouts have been developed to be consistent with the evidence provided in the dietitian/health professional tools. How can you access the PEN Client Handout Collections?

Go to the PEN home page and in the middle of the page click on PEN Client Handout Collections. There you can access English, French, translated and culturally adapted handouts for a variety of diet and nutrition related topics.

Stay tuned for some updates and new topic areas added to the PEN Client Handout section in 2012.

We welcome your ideas and suggestions on client handouts and resources you need in your practice. Email us at eNews@pennutrition.com

Written by
Beth Armour, PDt, MEd, PEN Content Manager

Conference reporting in 2012 – the ways they are a changin’!

Traditional conference reporting is taking copious notes, returning back to the workplace, trying to decipher those notes and then sharing with your colleagues what you learned. Nowadays, with technology and social media there is no reason to wait until you are back to work to share.... if the conference venue has WiFi or very strong cell/mobile phone reception, you can tweet, post and blog during the conference from your Notebook, Tablet or Smartphone.

Sounds like a great idea right? While tweeting and posting every exciting thing you hear and see at the conference may be fun and novel for you, what about for your social media followers? Recently several people I follow on Twitter were at the same conference and my Twitter page went wild with non-stop reports of conference activities from the innovative health breaks, to who they saw, who said what and how much fun they were having. Most of what was being reported would have been great for a personal page or wall but not professional or business related ones.

In social media we need to think about sharing the right information with the right audience. For the PEN Twitter, Facebook and LinkedIn pages reporting on new evidence or trends that may change practice (as presented by a speaker or a poster presentation), or highlights of an interesting chat with a colleague about knowledge translation would be appropriate. Looking at this year’s Dietitians of Canada (DC) conference program the following might provide interesting information for our social media followers:

did you attend a particular session which provided some new evidence that might impact practice: caffeine found in over x products from foods to medicine in Canada - what about your country? (DC session on The Caffeine Story)
did you learn a new term that we will be hearing more about in practice - e.g. "greenwashing"; "food system literacy" (DC session on Thinking beyond our plates: Critical questions to find food truth)
did you hear about a new research project - Canadian Malnutrition Task Force is conducting a pan-Canadian study on malnutrition prevalence in acute care and its impact. For more info see..... (DC Session Malnutrition in Canada: A call to action!)

Here are some social media guidelines for conference reporting:

Be prepared and considerate:

ask conference organizers if there is an official hashtag for the conference – if you use a social media tool such as Tweetdeck or Twitterrific pre-program it with the official conference hashtag.

For this year’s DC conference there isn’t an official conference hashtag but the PEN social media hashtag will be: #EBdiet

be aware of those around you. If you are tweeting during a session and it appears to be distracting to others, go to the back of the room. You might find more power sources there as well.
make certain you have your device charger with you.

Be consistent with your professional brand.

social media can be fun but keep your posts/tweets/contributions professional .
conference tweets and posts should add value for your followers and should not be made up of complaints or negatives.
if you are frequently tweeting and/or posting make certain every so often you repeat what event you are reporting from.
if you are reporting what a speaker said, make certain you have interpreted it correctly.

Be a part of the conversation

if there is a hashtag check it from time-to-time to see if anyone else is covering the same session thus avoiding duplicate / similar tweets and posts.
if you are stimulating some conversation try to reply to it in a timely manner and thank them for their contributions to the discussion.

How have you used social media at conferences? Tell us about your social media experience. Email us at eNews@pennutrition.com or post on our Facebook wall at www.facebook.com/pennutrition

Dietitians Dietetic Practice Social Media

Social Media: Dialling into the Digital Age Part I

Highlights of this article have been drawn from the Dietitians Association of Australia’s, ‘Dialling into the digital age: Guidance on social media for DAA members’ resource (2011). Authored by Emma Stirling, and DAA Reference Group members Catherine Saxelby, Zoe Nicholson, Tara Diversi, Sally Johnston, Lisa Simpson, Maree Garside, and Frances Gilham.

Are you engaged in social media? Interested in using social media, but want some guidance on how to do so professionally? In 2011, the Dietitians Association of Australia published a resource for its members to provide this kind of guidance. Over the next six issues of PEN eNews Volume 2, we will provide highlights of this new resource to help you dial into the digital age with confidence and professional integrity.

“Social media is not a passing fad. It is simply a new way of communicating. New environments pose new challenges, but also exciting

opportunities. Many of us will need to learn new skills to simply keep up with our savvy students and the next generation of digital natives. And many of us will shine and drive nutrition innovation for the profession, in this emerging space that easily amplifies our voice. If we embrace social media, we are more likely to win the race and stake our rightful place, as the online, ‘go to’ experts in nutrition. We hope these tips encourage you to dial into the digital age with confidence and professional integrity.” Julie Dundon DAA president.

Tip #1 – Don’t be anti-social! You will be more successful on social media if you publish positive, meaningful and respectful content. Remember that even if you post a nutrition comment as an individual, you are representing the profession as a whole. A comment you post in the heat of the moment can still appear in search engines years after you have cooled down.

Aim to:

Take time to listen and get to know a platform and community before you engage or start promoting your messages and content.
Avoid remarks that are offensive, untruthful, threatening, discriminatory or demeaning.
Respect diversity and remain appropriate and polite when disagreeing with others’ opinions.
Pause and think before posting – is the communication channel appropriate for the message you are sending?
Consider conducting a private, off-line conversation or direct message if you have an issue with a person or their content.
Regularly search for your name, practice or organization online and assess the content that ranks highly. Contact anyone posting material about you that is inappropriate.
Project a positive image of what we do. Every dietitian plays an important role in the success of the profession and our public image.
Pay it forward and support your colleagues by sharing, commenting and promoting their expert content with acknowledgement. The success of one dietitian contributes to the success of many.
Be a ‘scout’ for compliments and criticisms of your national dietetic association. If you come across positive or negative remarks about your association through social media that you believe are important, forward them to the organization.
Be aware of your dietetic association’s policies and guidelines when it comes to engaging in social media.
Maintain your obligation to your professional or regulatory body’s Code of Professional Conduct and report any concerns about unsatisfactory professional conduct to the appropriate body.

Stay tuned for Tip #2 in the next PEN eNews 2(2).

Media Nutrition Communication Social Media

Written by
Heather Petrie, MSc, RD, Evidence Analyst Contractor

Part 2: Flaws in

the Diamonds –

What are the limitations of systematic reviews?

A systematic review is a study on its own and its subjects are the individual primary studies. If the data from the individual studies can be pooled statistically then a meta-analysis can be performed - this is a quantitative systematic review. If the data cannot be pooled, which may occur if there are too few studies or they are too different, the collected articles are at least summarized (ideally in tables) - this is a qualitative systematic review.

In part I of this article, Diamonds in the Forest, the advantages of systematic reviews over individual primary studies and narrative reviews were reviewed. Part II of this article will examine the limitations of systematic reviews. While systematic reviews are considered a high level of evidence, they are not immune to bias and validity issues.

Here are some important limitations to consider:

A systematic review cannot compensate for poorly designed or biased original research.
If rigor is lost in the design of a systematic review (see Part 1), then the review quality decreases and the risk that conclusions could be misleading increases.
Search strategies must be very comprehensive. Ideally investigators search multiple databases, reference lists and bibliographies, contact experts in the area and do not limit citations to the English language. Efforts should be made to find and consider unpublished data to help combat publication bias. See here for more information on publication bias: http://www.cochrane-net.org/openlearning/html/mod15-2.htm
Criteria for evaluating the quality of included studies can vary among different reviews.
Different meta-analyses [quantitative systematic reviews] on the same subject can sometimes have different results. Often this is because authors included different studies or used different statistics.
Confusion can occur when a large study is published after a meta-analysis and the results do not concur.
It is important that reviewers and authors not have a vested interest in the outcome of the review such as may occur if they publish in the area or have commercial or advocacy group interests.
Bias can be apparent when the authors’ conclusions do not entirely match the results.
Like any study, meta-analyses have the potential to be misused or misinterpreted. Hence it is important for those reading meta-analyses to carefully examine the specific population, intervention/exposure, comparison, outcome (PICO/PECO) in the studies and be sure that it matches the scenarios in their practice.
The initial review is resource and time intensive, often taking at least six months or more to produce.
Many areas in the field of nutrition and dietetics can be difficult to evaluate with a meta-analysis because of the complex nature of diets and treatment and management strategies.

See the following free resource for evaluating the quality of a systematic review: http://www.cebm.net/index.aspx?o=1157

The bottom line - take a balanced look at systematic reviews:

Compared to other types of publications, systematic reviews are less vulnerable to the limitations above when they are properly designed and executed. However, it is important not to take conclusions at face value just because they are from systematic reviews. Best evidence needs to be combined with other information, knowledge, experience, clinical judgement, treatment costs and availability, and patient preferences, values and situations.

The following short and humorous systematic review illustrates these points: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Was this article helpful? Email us at eNews@pennutrition.com

"Our role on the PEN Team involves..."

PEN Insider

Spotlight on Kerri Staden BSc RD and Jane Bellman MEd, RD

Kerri Staden BSc, RD
PEN Resource Manager,
Dietitians of Canada

Jane Bellman MEd, RD

PEN Resource Manager,
Dietitians of Canada

Together, Kerri and I make one full-time PEN Resource Manager. Our role involves managing all aspects related to Tools and Resources in PEN. A huge project you must be thinking, and you are right! We have top-notch guidance from all the PEN team members, along with you the PEN users, many of whom recommend, review and provide resource ideas. We combine this guidance and ensure it is reflected in the PEN tools and resources.

A day in our lives as PEN Resource Managers…

Each day never seems quite the same. PEN is home to over 2300 tools and resources, which are both PEN developed and from external sources. Much time is spent making sure the content is consistent with the practice guidance in PEN, and meeting our user and their clients' needs.

Biggest learning from evidence-based practice:

PEN is excellent at providing the science behind dietetic practice (the why we do what we do). Our focus now is make the practice part of PEN more vibrant (the how-to in practice). Over the coming year, you will see more practice tips, recommendations, and easier-to-find tools and resources in PEN. Stay tuned for some focused opportunities through PEN, and via surveys to provide input into tools and resources on PEN - what type; how they should be presented and accessed.

What impact does evidence-based practice have on nutrition and dietetics?

Many times the words, 'practice makes perfect' are said to encourage excellence. However, if the practice is not right, excellence is difficult to achieve. What is great about PEN is the science is provided so practitioners can practice confidently with the information. Our goal with PEN this year is to improve upon how users can more easily access the evidence-based Tools and Resources for their practice.

Our favourite thing about PEN is…

It's dynamic. We are always working on something to improve or add to PEN. The other best part is connecting with many of you, which helps ensure that we are providing the best possible resources to meet your needs. There are some really great things happening in dietetics in Canada and in our partner countries - it is exciting to learn about and include them in PEN.

How to reach us…

jane.bellman@dietitians.ca

519-823-0252

kerri.staden@dietitians.ca

403-242-4458

Have more questions about what the PEN team does for you? Contact us at eNews@pennutrition.com

Student corner:

How PEN Has Enhanced My Learning Experience

Laura Belsito
University of Guelph
Masters of Applied Nutrition Student

PEN has helped me efficiently find reliable, nutrition information specific to certain disease states. I search for a nutrition specific topic and instantly find a variety of evidence-based practice summaries and resources to use for myself and for clients. I discovered PEN during my first clinical placement rotation in primary care at a family health team, as part of my Masters of Applied Nutrition program work. Before I discovered PEN, I found it difficult to search for well-established information, practice guidance and tools and resources. I would spend hours searching for practical, reliable information. When I have been unable to find client friendly handouts and resources, I have even created my own handouts! Then I found PEN.

I once counseled a client who was lactose intolerant. I wanted to ensure I knew the relative lactose content of different foods as well as the hidden sources of lactose. To prepare for the arrival of my client, I reviewed PEN resources and printed out a variety of handouts for the client - “managing lactose intolerance”, “food sources of lactose” and “food choices for reducing the lactose in your diet”. Because PEN provided the resources I needed, the counseling session went very well. The client was pleased and left the appointment better informed.

The usability and convenience of PEN has helped advance my dietetic training and professional career. I know where I can easy find reliable, practical nutrition information for school and placement assignments. I love to browse PEN and learn about nutrition topics I am less familiar with – as a result, I have become more knowledgeable about diverse topics in nutrition. Thanks PEN for making researching nutrition information a fun and easy task!

Want to share an innovative way you have used PEN for your learning? Write to us at eNews@pennutrition.com

Knowledge Transfer Events and Resources

Want to help clients separate fact from fiction?

@PubMedHealth is a starting place for the public looking for basic health information on the internet. They are trying to draw people’s attention to clinical effectiveness resources including the summaries of systematic reviews, and resources on understanding research. For more information, see: http://ow.ly/aXtaV

Follow #EBdiet for PEN’s knowledge transfer of new evidence

At the Dietitians of Canada conference, June 14-16, 2012, PEN plans to tweet about new evidence to facilitate knowledge translation to all PEN followers on twitter. We will use the hashtag #EBdiet to stream in tweets about knowledge transfer and evidence-based practice.

What is a hashtag? The # symbol, called a hashtag is used to highlight a key word or topic in a tweet (used in Twitter). Clicking on a hash-tagged word in any tweet shows you all other tweets that used the same hashtag. Some popular nutrition hashtags include #RDchat #RDUK #ICD2012 and #HealthyWtWk

International Congress of Dietetics

Attend the 16th International Congress of Dietetics in Sydney Australia from September 5 – 8, 2012. The ICD2012 organising committee looks forward to welcoming you to Sydney! Join the conversation at the official ICD2012 Facebook page: www.facebook.com/icd2012 or follow ICD on Twitter @icd2012. Hear about ICD news and events, and the latest nutrition research – and be part of a community that is passionate about... ICD2012! http://www.icd2012.com/

Heart UK 26th Annual Conference: Metabolic Syndrome, Obesity and Pre-Diabetes
June 27 – 29, 2012 THE conference for medical, scientific, student and patient attendees with an interest in lipids, atherosclerosis, cholesterol conditions, cardiovascular disease and nutrition. http://www.heartuk.org.uk/index.php?/events/heart_uk_26th_annual_conference_2012/

Know of a knowledge transfer event or resource? Email us at eNews@pennutrition.com

PEN does not have editorial or other control over the contents of the referenced Web sites. We are not responsible for the opinions expressed by the author(s) of the knowledge transfer events and do not endorse any product or service.

PEN eNews may contain links to other external websites. Dietitians of Canada, The British Dietetic Association, the Dietitians Association of Australia and Dietitians of New Zealand are not responsible for the privacy practices or the content of such external websites and do not endorse the content, products or services on other websites.

Announcements from PEN

Help Wanted - Cholesterol!

The PEN Healthy Eating: Cholesterol client handout has under gone a transformation to become: Eating Guidelines for Healthy Blood Cholesterol Levels.

While this handout has been reviewed by a number of dietitians, before we post it on PEN we welcome further feedback from our PEN users who specialize in both primary and secondary care settings where this handout would be used. If you are interested in participating, either yourself, your clients, or both, please send your name and email address to jane.bellman@dietitians.ca.

Continuing to be social!

We have invited you to like us on Facebook and Follow us on Twitter @pennutrition. We now invite you to connect with us on LinkedIn, all of which provide forums to continue the conversation about evidence-based dietetic practice.

Do you access by site license? Want to help your staff access PEN eNews?

Sign up at www.pennutrition.com/enews

Include PEN in your regulatory body continuing education activities this year!

For many Canadian Dietitians, this is the time of year when they are working on their ongoing professional learning plans or competency attestation activities for their provincial colleges. For DAA members, this is the time for maintaining Continuing Professional Development logs. Remember, writing or reviewing PEN content is an accepted learning activity! Reviewing a PEN knowledge pathway for personal learning is also accepted as equivalent to reading a journal article by many. PEN is also pleased to be recognized as a content reference for the Canadian Dietetic Registration Exam. Put PEN in your plan!

UK dietitians, were you selected for the HPC audit?

Every two years, a proportion of UK dietitians will be audited by the Health Professionals Council. Were you selected? If so your continuing professional development (CPD) portfolio will need to be submitted by June 30th. Did you know that dietitians can add PEN to their CPD portfolio? If you have reviewed pathways, written PEN factsheets or developed your own factsheets for use in the clinical setting, which have been informed by PEN content; these can all be used as proof of CPD for your portfolio. Another way of using PEN in your CPD portfolio is to write reflections (an essential skill for UK dietitians in proving their CPD). How has your practice changed since being informed by the information on PEN. Add PEN in your plan!

'Like' ICD2012 on Facebook

Connect with your overseas colleagues and join the world-wide excitement around the International Congress of Dietetics 2012 to be held in Sydney September 5-8 this year www.facebook.com/ICD2012 Through the Facebook page, you’ll receive the latest news and updates on ICD, including speaker profiles, and research highlights.