Expanding the primary care workforce to alleviate general practitioner (GP) workload, improve access and improve quality of care is a current UK strategy. Evidence suggests dietitians can improve patient outcomes and make cost savings. The present study aimed to evaluate a dietitian working as an expert generalist and first contact practitioner (FCP) in a general practice multi-disciplinary team (MDT) to provide appropriate care to patients and reduce GP workload.
A dietitian was employed for 6 months at 0.6 full-time equivalents in a group of general practices in Devon, UK. Data were collected on the referral source, patient satisfaction, health outcomes and changes in prescribing data for all patients seen by the dietitian. Focus groups and interviews provided data to understand the experience of introducing a dietitian into the team.
This model of service delivery showed the dietitian acting as an expert generalist, a FCP and able to educate the MDT. A range of professionals within the MDT referred patients with a wide range of diagnoses (both paediatric and adults) and the dietitian acted as a FCP for 29% of patients. Saving were made for the optimisation of medicine management.
The dietitian can improve patient-centred care for several patient groups; enhance learning for staff around nutrition and dietary issues; and contribute to more efficient working and cost savings around prescription of nutritional products. This was an evaluation of one service and further research is needed to understand the value dietitians can contribute and the factors supporting effective and efficient working in this context.

This case study follows a professional internationally capped female soccer player\'s two-year journey from eumenorrhea, through injury, to amenorrhea, and the challenges faced by the player and nutritionist. The two years are split into three sections: (Areta et al. 2013) longitudinal profiling of the player, (Baker et al. 2020) nutrition to support her return from injury, and (Beato et al. 2018) investigation into the observed secondary amenorrhea. The cause of amenorrhea was investigated through the assessment of energy availability via doubly labelled water, remote food photography, blood biomarkers and resting metabolic rate. Despite having secondary amenorrhea and anovulatory cycles, the player did not have low energy availability. This study shows the importance for practitioner\'s, particularly nutritionists, to not assume that all menstrual irregularities are caused by low energy availability and could be caused by a combination of factors (e.g., clinical, physiological, and psychological), which requires a multi-disciplinary investigation and intervention team. This study also showed that education needs to be provided about menstrual health to elite female soccer players as the player (i) believed that not having a period was beneficial for performance and unsure of possible health implications; (ii) was convinced that a one-day bleed indicated a regular menstrual cycle; and (iii) was reluctant to waste the practitioners time discussing menstrual issues and was nervous of finding out if she had an actual health issue. It is therefore crucial that players feel comfortable in discussing their menstrual status with practitioners to support their performance and long-term health.

To improve hospital malnutrition care, assessing actual malnutrition practices and knowledge is essential. Our objectives are to assess malnutrition care practices, evaluate dietitians\' malnutrition knowledge, and explore barriers and facilitators to optimal malnutrition care in a LMIC hospitals.
This is a national cross-sectional study of mixed-method design. Two questionnaires from the Malnutrition Quality Improvement Initiative were used to assess malnutrition care practices and dietitians\' malnutrition knowledge. In-depth interviews were used to investigate barriers and facilitators to optimal malnutrition care.
Mean average for malnutrition care practices score was 20.96 out of 30 (N = 56). Factors affecting malnutrition practices were: (1) private/public affiliation of the hospital and (2) presence of a documented malnutrition protocol. Dietitians (N = 62) working at academic hospitals scored 57% for malnutrition knowledge which was higher than the score for those working at non-academic hospitals (44%). Gaps in malnutrition knowledge among hospital staff, shortage in hospital staff, and lack of financial coverage for nutrition therapy were the main barriers identified from eight in-depth interviews.
Efforts should be taken by decision makers to facilitate malnutrition care and increase malnutrition awareness among healthcare professionals.

Implementation science theories, models and frameworks help to address evidence-practice gaps, which have increasing importance for dietetic practice. This paper aims to provide dietitians with insight into how implementation science can be applied to practice, using multiple \'real-life\' case studies.
Three case studies were purposively selected across areas of dietetics practice to demonstrate application of commonly-used implementation theories, models and frameworks. Reflections from the authors were provided in response to a structured set of questions outlining how the theoretical approach was selected and used, and considerations for future application. Within and cross-case analysis was undertaken.
Dietitians used diverse implementation theories, models and frameworks to identify barriers and enablers, to plan for implementation, and to guide the selection of implementation strategies. Implementation theory was used to evaluate the implementation process in one case study. Cross-case analysis identified that mentoring by those with implementation expertise, multidisciplinary implementation teams, and leadership and investment in research and translation at an organisational and departmental level as key enablers.
This paper offers dietitians insight into how implementation science can be applied to improve the uptake of evidence-based practices within nutrition and dietetics, and suggests that there needs to be investment in implementation science as a foundation science within nutrition and dietetics, including education, training and mentoring for dietitians.

The study sought to establish the role of health professionals in promoting peace through health care using a case study of Chegutu Urban District in Zimbabwe. The participants were drawn from health professionals employed in three council clinics and were interviewed on their views on programmes that promote peace and end violence. Their narratives were thematically presented. Results revealed that although the participants had ideas on how to promote peace through health care, did health education and assisted victims of violence, their programmes were inhibited by several challenges, predominantly related to the state of the Zimbabwean economy. The study recommended a systematic focus on these challenges so that the health professionals can realize their potential. The study also recommended further research into the impact of village health workers in community peace and the use of a multisectoral approach to managing artisanal violence.

A recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of \"Food Service Dietitian\", comprehensive training courses were developed (70 dietitians participated).
To examine the impact of the addition of the role of a \"Food Service Dietitian\" in medical institutions on suitability of foods served, food costs and food waste.
A three years (2014-2017) national case study to examine the new role\'s impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal.
Kitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors: 1.Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)2.Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.3.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).4.As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient\'s medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum.
Implementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.

Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions.
Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity.
Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork.
Reflective comments from students regarding the interprofessional experience are evidence of this initiative\'s benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.

Lifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment.
Our aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians.
We conducted qualitative constructivist phenomenological research.
In-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model.
Most dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change.
Changes in the spatial design in which the therapeutic interaction occurs might support the dietitians\' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians\' awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.

Athletes are at higher risk than the general population for eating disorders, and risk is heightened for athletes in thin-build sports, including track. Collegiate athletes are particularly vulnerable to disordered eating when the transition from home to the college environment adds to the stress of performance pressures and the high demands of the sport environment. Male and female athletes who develop eating disorders share some common characteristics, yet their experiences can be quite different, in part as a consequence of their sex and how eating disorders develop, and are recognized, acknowledged, and treated, within the culture of sports. This case report describes the experiences of two track athletes, one male and one female, who were recruited to the same Division 1 collegiate track program. Both were elite athletes, freshmen in the same year, experiencing the same urban college environment, and experiencing an eating disorder characterized by restrictive eating, significant weight loss, injury, and compromised performance in sport. Both received treatment from a multidisciplinary team of professionals. Both athletes achieved weight restoration, recovery from the disorder, and success in their sport. In spite of the similarities, striking differences were apparent in clinical presentation, predisposing features, onset of symptoms, entry points to treatment, interventions received, and clinical courses through treatment that depict sex differences in how eating disorders present in athletes and are addressed in the sport environment. Findings endorse the need for research and inform prevention strategies, risk assessment, and intervention approaches for nutrition and sports medicine professionals and collegiate athletic departments.

The field of Mobile health (mHealth), which includes mobile phone applications (apps), is growing rapidly and has the potential to transform healthcare by increasing its quality and efficiency. The present paper focuses particularly on mobile technology for body weight management, including mobile phone apps for weight loss and the available evidence on their effectiveness. Translation of behaviour change theory into weight management strategies, including integration in mobile technology is also discussed. Moreover, the paper presents and discusses the myPace platform as a case in point. There is little clinical evidence on the effectiveness of currently available mobile phone apps in enabling behaviour change and improving health-related outcomes, including sustained body weight loss. Moreover, it is unclear to what extent these apps have been developed in collaboration with health professionals, such as dietitians, and the extent to which apps draw on and operationalise behaviour change techniques has not been explored. Furthermore, presently weight management apps are not built for use as part of dietetic practice, or indeed healthcare more widely, where face-to-face engagement is fundamental for instituting the building blocks for sustained lifestyle change. myPace is an innovative mobile technology for weight management meant to be embedded into and to enhance dietetic practice. Developed out of systematic, iterative stages of engagement with dietitians and consumers, it is uniquely designed to complement and support the trusted health practitioner-patient relationship. Future mHealth technology would benefit if engagement with health professionals and/or targeted patient groups, and behaviour change theory stood as the basis for technology development. Particularly, integrating technology into routine health care practice, rather than replacing one with the other, could be the way forward.