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Background: A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical‐care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7. Methods: A cross‐sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28). Results: Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05). Conclusions: There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well‐resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes. Highlights: Having a paediatric dietitian as part of a multidisciplinary team in paediatric intensive care units (PICU) predicts optimal enteral energy and protein intake.PICUs within the UK and Republic of Ireland do not meet minimum dietetic staffing standards.There is a significant disparity in seniority levels between adult and paediatric dietetic staff in critical care. [ABSTRACT FROM AUTHOR]

Background: Cancer survivorship is associated with co‐morbidities including anxiety, depression and cardiovascular disease (CVD). Rehabilitative care post‐treatment is vital for survivors' psychological and physical well‐being. The present study aimed to investigate breast cancer survivors' attitudes towards their health post‐treatment; their awareness of co‐morbidities associated with treatment; and their awareness of support systems available. Methods: A qualitative research approach was employed, using semi‐structured interviews with breast cancer survivors from the UK and Ireland. Data were analysed using thematic analysis. Eight breast cancer survivors were recruited through purposive sampling. Results: Two themes emerged from the data: (1) health and rehabilitation post‐treatment, which included mental and physical health and a desire to control one's own health in survivorship as well as a discussion around co‐morbidities, and (2) access to support services in survivorship, which highlighted both positive and negative experiences of accessing support, as well as reasons for not accessing support in survivorship. Conclusions: Access to rehabilitation support, including diet, exercise and stress management, is key to survivorship. Rehabilitation and support services need to be more readily available for survivors to aid them in this journey and to educate them on the increased risk of conditions such as CVD with cancer treatment. Utilising current cardiac rehabilitation models could be a solution to provide a holistic cancer rehabilitation, thus providing the lifelong support that cancer survivors both want and need. Key points: Access to rehabilitation support, including diet, exercise and stress management, is key to survivorship; however, access to support differed and was lacking for many survivors. Longer‐term comorbidities of cancer treatment were not fully understood. Therefore, there is a need for rehabilitation and support services to educate survivors on the increased risk of conditions such as cardiovascular disease with cancer treatment. These services must also address long‐term risk through lifestyle factors, including diet and physical activity. Utilising current cardiac rehabilitation models could be a solution to provide a holistic cancer rehabilitation, thus providing the lifelong support that cancer survivors both want and need. [ABSTRACT FROM AUTHOR]

Background: Oral health is affected by dietary practices and may impact quality of life. Collaboration between dietetics and dental professionals for oral health promotion and disease prevention is recommended. The present study aimed to determine the knowledge and practice of dentists and dietitians on diet and dental health. Methods: The study comprised a cross‐sectional online questionnaire, which was disseminated electronically to dentists and dietitians in the UK and Ireland, via national networks. Questions assessed participants' knowledge of the cariogenicity of different foods, snacking behaviours, familiarity with UK dietary guidelines, dietary advice and their recommendations for cross‐professional consistency. Results: In total, 418 responses were received (60% dentists, 40% dietitians). Inter‐profession knowledge differences were observed for the cariogenicity of sports drinks (p < 0.001), chocolate/confectionary (p < 0.001), yoghurt (p < 0.001) and sugar‐coated breakfast cereals plus milk (p < 0.0001). Dentists showed greater concern over the timings and frequency of food consumption than dietitians. A greater proportion of dentists felt nutrition and oral health counselling is a key component of regular patient care (58.4% versus 8.2%, p < 0.001). Only 18% of dietitians, compared to 56% of dentists, considered that they had received sufficient training about diet and dental health. Both professions indicated the need for multi‐disciplinary training. Conclusions: Dietitians and dentists differ with respect to their knowledge about the effects of snacks and snacking behaviours on dental health, as well as how they prioritise this in their clinical practice. Both professions show a willingness to work collaboratively to ensure accurate and consistent advice‐giving and expertise‐sharing. [ABSTRACT FROM AUTHOR]

Background: In 2012, the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for Epilepsies: Diagnosis and Management (CG137) included, for the first time, ketogenic diets (KDs) as a treatment option for drug‐resistant paediatric epilepsy. The recommendation was made to refer children and young people with epilepsy whose seizures have not responded to appropriate anti‐epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of KDs. We aimed to assess the impact of this change in guidance on the numbers of ketogenic centres and patients following KDs for epilepsy in the UK and Ireland. Methods: An online survey was circulated to ketogenic dietitians from the UK and Ireland. The results were compared with similar surveys published in 2000 and 2010. Results: The number of centres offering KDs for treatment of epilepsy has risen from 22 in 2000, to 28 in 2010, and to 39 in 2017 (77% overall increase). Seven of these centres accept adult referrals, in comparison to only two centres in 2010. Patient numbers have increased from 101 in 2000 to 754 in 2017. In total, 267 patients are waiting to commence KD at 31 centres. Conclusions: Over the last 7 years, the number of patients treated with a KD for epilepsy in the UK and Ireland has increased by 647%, with a 77% increase in the number of centres offering KDs. Despite this rapid growth, there is ongoing demand for patients to be considered for dietary therapy, highlighting the need for continued expansion of KD services nationally. [ABSTRACT FROM AUTHOR]

Background: Many centres across the UK and Ireland anecdotally report using a 'modified ketogenic diet' (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols. Methods: An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD. Results: Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD 'prescriptions' on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein ad libitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n = 18; fat lists n = 13) and 'household measures' (carbohydrate lists n = 2; fat lists n = 3). Of the centres, 94% (n = 17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n = 14). Ketogenic nutritional products available on prescription were used by 10 centres (56%) when initiating and by all centres when 'fine‐tuning' the MKD. Conclusions: A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost‐effectiveness of MKD would be of benefit. [ABSTRACT FROM AUTHOR]

Background The present study was undertaken to review how much time paediatric dietitians spend in direct contact with patients and to determine what levels of staffing are available throughout paediatric dietetic departments in Ireland and the UK. Methods A work sampling tool was devised to capture paediatric dietetic activity for a period of 1 day. A semi-structured questionnaire was sent to paediatric dietitian managers to provide demographic information on their facility. Results Fourteen questionnaires were returned by paediatric dietitian managers and 86 work sampling tools were returned for analysis by dietitians working in the various departments. Paediatric dietitians spend 23% of the working day in direct patient contact, although up to 58% of the day in direct patient-related activities, of which communication comprised 25.2%. Staffing levels are below clinical recommendations in four out of five specialties. National activity reports focus on the number of patient contacts but do not include information on the complexity of patient care. Conclusions Work sampling is a useful tool in the assessment of activity in healthcare. Inadequate staff levels and limitations in activity reporting in paediatric dietetics will affect estimations for future service developments. Information obtained from the present study could contribute to the supply analysis of a workforce planning exercise in paediatric services in the future. [ABSTRACT FROM AUTHOR]

Background Despite evidence that even mild dehydration is associated with various morbidities, water intake estimates in free-living populations are lacking. The present study aimed to estimate water intakes and dietary sources in a nationally representative sample of the Irish adult population. Methods A 4-day semi-weighed food record was used to collect dietary intake data from 1500 free-living adults aged 18-90 years in the Irish National Adult Nutrition Survey ( NANS) (2008-2010) from which water intake was estimated. To enable fluid intake estimation, additional questions on how water and milk were consumed were incorporated. Total water intake was calculated as drinking water plus water from other beverages and food moisture. Results The mean ( SD) daily total water intake for Irish adults was 2.31 (0.92) L day-1 [males 2.52 (1.00) L day-1; females 2.09 (0.79) L day-1]. Intakes were lowest in elderly adults, as well as in those with less education, a lower social class, less energy expenditure and a higher body mass index and body fat percentage. In total, 67% of water came from beverages and 33% came from food moisture. Alcoholic beverages and teas individually contributed to total water intake in amounts similar to the drinking water contribution. Conclusions These data may be used as a foundation for further research in the area of the effect of under consumption of water on health outcomes to guide public health messages regarding adequate water intakes. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "This work was supported by the NIHR GOSH BRC" which appeared in the previous issue.