Nutrition Intervention through Interdisciplinary Medical Treatment in Hospice Patients: From Admission to Death

The demand for hospice services as well as for ‘well-dying’ of terminal patients is increasing as patient financial burden is decreasing due to National Health Insurance coverage for hospice care. Hospice institutions utilize interdisciplinary teams comprising doctors, nurses, dietitians, and other health staffs to provide comprehensive patient management. This report examined the nutritional status of a hospice patient from admission to death as well as the nutrition management of this patient in the hospice ward through nutrition interventions performed by a dietitian in the interdisciplinary team. The patient in the present case was a 74-year-old man diagnosed with pancreatic head cancer who died after 26 days of hospice care following transfer from the general ward. During hospice care, the dietitian monitored the patient's nutritional status and performed 8 nutrition interventions, but his oral intake decreased as the patient's symptoms worsened. The average energy intake rates were 30% and 17% of required rates for oral and artificial nutrition, respectively. In line with a report suggesting that the main focus of nutrition in palliative care should be on improving the quality of life and reducing worry in patients, rather than aggressive nutritional management, there is a need for nutrition interventions that are personalized to individual patients by monitoring progress and offering continuous counseling from the time of admission. In addition, further studies such as comparative analysis of nutritional management in Korean hospice ward will be needed for better nutrition management for terminally ill patients.

Case Study on Safety Situation and Awareness through Risk Assessment of Hospital Foodservice Kitchen Area

This study was carried out to provide a basis for the development of a safety manual for kitchen accident prevention by identifying the safety situation and awareness through risk assessment of kitchen areas. The study was conducted in two phases. First, kitchen accidents and area risk assessment were investigated from February 2014 to September 2014, after which safety awareness of hospital foodservice employees was assessed in a survey. The results of this study were as followes. All of the respondents were women. The evaluation point of kitchen area risk assessment was reduced by 14%. After improvement, an initial score of 108 points decreased to 93 points. The number of accidents was also reduced by 78%; 14 accidents were decreased to three. The most common area of accidents was the kitchen area (58.8%), and burns was the most common accident (35.3%). Most of the employees deemed "enough staff" as the most major factor for good foodservice. "High indoor temperature and poor ventilation in the kitchen area" was chosen as the most common problem in the foodservice workplace. Taken together, our study quantitatively evaluated safety issues in hospital foodservice kitchen areas and provides a basis for the development of a safety manual for kitchen accident prevention.

Case Study on Improvement of Hospital Foodservice by Introduction of FMEA Techniques: Focus on Food Delivery Service Quality and Customer Satisfaction

In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.

Comparison of Nursing Records and the Catholic Medical Center Nutritional Risk Screening as a Nutrition Screening Tool for Intensive Care Unit Patients

In the present study, we aimed to compare the results from nutritional risk screening based on nursing records with those using the Catholic Medical Center Nutritional Risk Screening (CMCNRS) tool. A cross-sectional study was performed involving 91 patients aged > or = 18 years from an intensive care unit. We collected general characteristics of the patients and nutrition screening was conducted for each patient by using computerized hospital program for the nursing records as well as the CMCNRS conducted by clinical dietitians. The subjects were aged 64.0 +/- 17.5 years, and 52 (57.1%) patients had a NPO (nothing by mouth) status. Neurological disease was the most common diagnosis (25.3%). Compared with the CMCNRS results from the clinical dietitians, the results for the nursing records had a sensitivity of 40.5% (95% CI 32.0-40.5) and a specificity of 100.0% (95% CI 92.8-100.0). The agreement was fair between the CMCNRS results obtained by clinical dietitians and the nursing records (k = 0.423). Analysis of the errors from the screening using the nursing records revealed significant differences for all subjective indicators (p < 0.001), compared with the CMCNRS by the clinical dietitians. Thus, after assessing the methods used for nutrition screening and the differences in the search results regarding malnourished status, we noted that the nursing records had a lower sensitivity than the screening by the CMCNRS.

The Relationship between High Energy/Low Nutrient Food Consumption and Obesity among Korean Children and Adolescents / 대한지역사회영양학회지

Consumption of foods with high energy and low nutrient values has been linked to various health issues including obesity and chronic diseases. This study investigated the high-energy/low-nutrient food consumption status and its relationship with obesity status and intake of energy and nutrients, using the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korea Youth Risk Behavior Web-based Survey (KYRBWS). The prevalence of overweight and obesity among 2-18 year-olds was 8.4% and 10.8% in 2008 and 8.5% and 9.0% in 2009, respectively, in KNHANES. The prevalence of obesity among 12-18 year-olds was 13.9% in 2008 and 11.4% in 2009 in KNHANES, while it was 8.1% in 2008 and 8.2% in 2009 in KYRBWS. Consumption patterns of high-energy/low-nutrient foods were diverse depending on the particular food type. High-energy/low-nutrient foods such as cookies were most often consumed more frequently (2~3 times per week), but fast food type foods were generally consumed less frequently (once per week or less). No significant relationships between high-energy/low-nutrient food consumption and level of energy and nutrient intakes were found in either datasets. Adolescents who were not obese more frequently consumed ramen (p < 0.001), cookies (p < 0.001) and fast food (p < 0.001) than those who were obese in KYRBWS, however, such relationships were not found in KNHANES. This direction of the relationship could be probably attributed to the cross-sectional nature of the datasets. This study was limited by the cross-sectional nature of the data, therefore, further longitudinal research using various study techniques would be necessary to understand the effects of high-energy/low-nutrient foods on child obesity.

Snack Consumption Behaviors and Nutrition Knowledge among Elementary School Students in Siheung-si / 대한지역사회영양학회지

Good snack consumption behaviors are important among elementary students because snack provides additional energy and nutrients and because good dietary behaviors should be formed during early stages of life. This study investigated, among elementary school students, 1) snack consumption behaviors, 2) snack-related nutrition knowledge level, and 3) relationships between snack behaviors and snack-related nutrition knowledge. A convenience sample (N = 372), drawn from 5th and 6th graders of an elementary schools in Siheung-si, Gyeonggi-do, completed a pre-tested questionnaire. More than 85% of the participants snacked more than once per week. Most (77%) had their snacks at home. Fruit and fruit juice were the most frequently consumed and the most liked snack items. Taste was the most important in choosing a snack item closely followed by health/nutrition. Snack-related knowledge level was relatively high and the participants obtained their nutrition knowledge through mass media (30.4%) and family/friends (29.0%). Snack-related nutrition knowledge level and snack consumption behaviors showed positive relationships in various areas such as choosing more nutritious snack items and checking nutrition labels. Although this study was limited by its cross-sectional study design, these positive relationships suggest that better nutrition knowledge could result in better behaviors. Results of this study indicated that factual nutritional knowledge has been well transmitted to students. Therefore, future nutrition education on snacking could focus more on providing problem-solving and operational knowledge.