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Elderly inpatients with coronavirus disease 2019 (COVID-19) are often at nutritional risk and at higher risk of critical disease. The standardized nutrition treatment could effectively improve the nutritional status, quality of life, and clinical outcomes of COVID-19 patients, and is an important component of the comprehensive management of COVID-19. The individualized nutrition diagnosis, treatment and monitoring should be conducted in compliance to standard procedures of medical nutrition therapy, with consideration of the clinical characteristics of elderly COVID-19 inpatients. The Department of Clinical Nutrition at Peking Union Medical College Hospital has integrated the latest clinical nutrition guidelines and clinical practice of nutrition support of COVID-19, with the aim to provide evidence-based, concise and practical recommendations on nutritional management for elderly inpatients with COVID-19. The recommendations here are to inform effective and standardized nutrition support practice.
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Objective:To explore the clinical characteristics and medical nutritional therapy of 6 patients with late-onset ornithine transcarbamylase (OTC) deficiency.Methods:The clinical features, biochemical data, gene variations and treatment outcomes of 6 children with late-onset OTC deficiency admitted to the Department of Clinical Nutrition, Children′s Hospital of Nanjing Medical University from January 2020 to April 2022 were retrospectively analyzed.The 6 patients were all intervened by a long-term medical nutrition management.Results:Liver dysfunction and hyperammonemia (172.1-348.0 μmol/L) were found in all the 6 children with late-onset OTC deficiency.Serum citrulline decreased in 3 patients (3.95-5.43 μmol/L). Three patients showed increased urine orotic acid (123.48-342.60 mmol/mol Cr). Urine uracil increased in 4 patients (106.77-1 207.26 mmol/mol Cr). Variations of the OTC gene [c.364G>C p. (E122Q), c.1028C>G p. (T343R), c.664-2(IVS6)A>C, c.635G>T p. (G212V), c.929_c.931delAAG p. (E310del), c.829C>T p. (R277W)] were identified in all patients.The 6 children were all managed by individualized medical nutrition program and followed up for a long time.During the follow-up period, 3 cases developed hypoproteinemia, acute metabolic crisis and growth retardation, 3 cases had normal growth and laboratory indicators, and 1 case received liver transplantation after 3 months of nutritional management. Conclusions:The clinical manifestations of OTC deficiency are non-specific.Blood amino acids, urine organic acids and genetic tests are important for the diagnosis.Long-term regular medical nutrition management is helpful to improve the prognosis and quality of life of children.
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Objective:To explore the application and effect of artificial intelligence technology in perinatal management of gestational diabetes mellitus.Methods:240 pregnant women with gestational diabetes diagnosed during 24-26 weeks of pregnancy in Changsha Maternal and Child Health Hospital were prospectively selected and randomly divided into control group (120 cases) and observation group (120 cases). The control group used the traditional management mode for nutritional management, and the observation group used AI technology for nutritional management. The weight gain, blood glucose control level, insulin use, pregnancy complications, pregnancy outcome and other indicators of the two groups were compared.Results:(1) Monitoring indicators during pregnancy: there was no significant difference in weight gain between the two groups ( P>0.05). The proportion of weight gain in the appropriate range in the observation group was significantly higher than that in the control group ( P<0.05); The prevalence of full-term anemia, insulin use rate and the incidence of blood glucose exceeding the control standard in the observation group were significantly higher than those in the control group (all P<0.05). (2) Pregnancy outcome: there was no significant difference in the incidence of gestational hypertension, cesarean section, fetal growth restriction, premature delivery and neonatal hypoglycemia between the two groups (all P>0.05); The incidence of conversion to cesarean section, macrosomia, neonatal blood glucose <2.6 mmol/L, mild asphyxia and admission to neurosurgical intensive care unit (NICU) in the observation group were significantly higher than those in the control group (all P<0.05). Conclusions:Application of AI technology to nutritional management of gestational diabetes can better control the maternal perinatal weight gain and blood glucose level, reduce the incidence of anemia in the third trimester of pregnancy, the incidence of macrosomia, the use of insulin and the rate of conversion to cesarean section, and improve the neonatal outcome.
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Objective:To analyze the effects of multidisciplinary cooperative nutrition management model in acute stroke patients with dysphagia.Methods:From February 2019 to February 2020, 69 acute stroke patients with dysphagia were enrolled in this study. After exclusion of those unable to complete the trial, patients were randomized into control group ( n=30) and experimental group ( n=30). Patients in the control group were given routine nutrition management, while patients in the experimental group were treated under multidisciplinary cooperative nutrition management model. Nutritional indicators were compared between the two groups on Day 1, 7 and 14 after admission, including levels of albumin (ALB), pre-albumin (PALB), hemoglobin (HB), triceps skin-fold (TSF) thickness on the uninjured side, upper arm muscle circumference etc. Incidence of gastrointestinal complications and infectious complications was also recorded. Results:There was no difference between two groups in the levels of HB, TSF thickness and upper arm muscle circumference on the uninjured side (all P>0.05). However, the serum levels of ALB and PALB on Day 7 and 14 in the experimental group were higher than that in the control group(all P<0.05), The incidence of gastrointestinal complications ( P=0.015)and infectious complications ( P=0.016) in the experimental group was lower than that in the control group. Conclusion:Multidisciplinary collaborative nutrition management improved nutritional indicators, reduced the incidence of gastrointestinal complications and infectious complications in acute stroke patients with dysphagia, making multidisciplinary collaborative nutrition management model worthy of clinical promotion and application.
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OBJECTIVES: Young athletes require adequate nutrition to maintain their athletic performance, growth and health. This study examined the status and needs of nutrition management and meal services for student athletes among the athlete's parents. METHODS: The subjects were parents of elementary, middle, and high school athletes (n=323) from 18 schools participating mainly in the Sports Food Truck. The questionnaire included general characteristics, status and needs on nutrition management and meal service for student athletes, and satisfaction with the Food Truck. The survey was done during 2018. The data were analyzed according to the school groups using a χ2-test or ANOVA. RESULTS: Approximately 45% of subjects had difficulty in the nutrition management of athletes, and 87.1% had not received nutrition education. Approximately 74% wanted nutrition education held for athletes, and mainly wanted topics on nutrition management for health and eating for athletic performance. The preferred methods were lectures and cooking activity. The responses on the necessity of nutrition education for athletes, desired education topics, and desired times for education differed significantly according to the school groups (p < 0.05). Most subjects also wanted nutrition information mainly through SNS. In the athlete's meal, breakfast and snacks were highlighted as the meal to supplement. Approximately 90.3% responded that providing a meal service is necessary. The subjects preferred snacks before/after exercise and dinner if a meal service was provided. They preferred Korean food, followed by snacks, and a dish meal. As the meal type, the subjects wanted the Food Truck and packed meal. The responses on necessity of a meal service (p < 0.05), preferred food (p < 0.001), and meal type (p < 0.001) in the meal service differed significantly according to the school groups. Approximately 43% were satisfied with the Food Truck and 50.8% responded as average. They made suggestions for the Food Truck in terms of foods, operations and frequency. CONCLUSIONS: Based on the study results, nutrition education and meal service may support nutrition for student athletes considering the needs of the parents according to the school groups.
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Humans , Athletes , Athletic Performance , Breakfast , Cooking , Eating , Education , Lecture , Meals , Motor Vehicles , Needs Assessment , Parents , Snacks , SportsABSTRACT
OBJECTIVES: Young athletes require adequate nutrition to maintain their athletic performance, growth and health. This study examined the status and needs of nutrition management and meal services for student athletes among the athlete's parents. METHODS: The subjects were parents of elementary, middle, and high school athletes (n=323) from 18 schools participating mainly in the Sports Food Truck. The questionnaire included general characteristics, status and needs on nutrition management and meal service for student athletes, and satisfaction with the Food Truck. The survey was done during 2018. The data were analyzed according to the school groups using a χ2-test or ANOVA. RESULTS: Approximately 45% of subjects had difficulty in the nutrition management of athletes, and 87.1% had not received nutrition education. Approximately 74% wanted nutrition education held for athletes, and mainly wanted topics on nutrition management for health and eating for athletic performance. The preferred methods were lectures and cooking activity. The responses on the necessity of nutrition education for athletes, desired education topics, and desired times for education differed significantly according to the school groups (p < 0.05). Most subjects also wanted nutrition information mainly through SNS. In the athlete's meal, breakfast and snacks were highlighted as the meal to supplement. Approximately 90.3% responded that providing a meal service is necessary. The subjects preferred snacks before/after exercise and dinner if a meal service was provided. They preferred Korean food, followed by snacks, and a dish meal. As the meal type, the subjects wanted the Food Truck and packed meal. The responses on necessity of a meal service (p < 0.05), preferred food (p < 0.001), and meal type (p < 0.001) in the meal service differed significantly according to the school groups. Approximately 43% were satisfied with the Food Truck and 50.8% responded as average. They made suggestions for the Food Truck in terms of foods, operations and frequency. CONCLUSIONS: Based on the study results, nutrition education and meal service may support nutrition for student athletes considering the needs of the parents according to the school groups.
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Humans , Athletes , Athletic Performance , Breakfast , Cooking , Eating , Education , Lecture , Meals , Motor Vehicles , Needs Assessment , Parents , Snacks , SportsABSTRACT
OBJECTIVES: This study aims to evaluate the economic efficiency of a nutrition management program for children under 5 years of age in Kenge, Kwango District, Democratic Republic of the Congo (DR Congo) from 2014 to 2016. METHODS: The economic efficiency of a nutrition management program for children under 5 years of age who have recovered from malnutrition status was evaluated using a cost-benefit analysis. The costs were analyzed according to the executed budget incurred during the project period. The benefits were estimated as the monetary value of the saved lives of children under 5 years of age. The economic efficiency of the program was determined by the Benefit-Cost Ratio (BCR). The BCR was calculated by dividing the total discounted benefit by the total discounted costs. The project is economically efficient when the BCR is greater than 1. RESULTS: The costs of the nutrition management program were calculated as 1,677,609,648 Korean Won (KRW). A total of 2,466 children survived with improved malnutrition status through this program. The benefit for the reduction of mortality for children under 5 years of age was estimated to be 6,814,354,467 KRW, the estimated value of life for 2,466 children. The BCR was 4.06. CONCLUSIONS: The nutrition management program for children under 5 years of age in DR Congo was found to be a cost-effective project. Successful and efficient Official Development Assistance (ODA) for a health project requires integrated and comprehensive strategies and specialized international development consulting to improve efficiency. Future nutrition management programs should take into account the national health program to maintain the sustainability of the project.
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Child , Humans , Budgets , Congo , Cost-Benefit Analysis , Democratic Republic of the Congo , Malnutrition , Mortality , National Health Programs , Value of LifeABSTRACT
OBJECTIVES: This study aims to evaluate the economic efficiency of a nutrition management program for children under 5 years of age in Kenge, Kwango District, Democratic Republic of the Congo (DR Congo) from 2014 to 2016. METHODS: The economic efficiency of a nutrition management program for children under 5 years of age who have recovered from malnutrition status was evaluated using a cost-benefit analysis. The costs were analyzed according to the executed budget incurred during the project period. The benefits were estimated as the monetary value of the saved lives of children under 5 years of age. The economic efficiency of the program was determined by the Benefit-Cost Ratio (BCR). The BCR was calculated by dividing the total discounted benefit by the total discounted costs. The project is economically efficient when the BCR is greater than 1. RESULTS: The costs of the nutrition management program were calculated as 1,677,609,648 Korean Won (KRW). A total of 2,466 children survived with improved malnutrition status through this program. The benefit for the reduction of mortality for children under 5 years of age was estimated to be 6,814,354,467 KRW, the estimated value of life for 2,466 children. The BCR was 4.06. CONCLUSIONS: The nutrition management program for children under 5 years of age in DR Congo was found to be a cost-effective project. Successful and efficient Official Development Assistance (ODA) for a health project requires integrated and comprehensive strategies and specialized international development consulting to improve efficiency. Future nutrition management programs should take into account the national health program to maintain the sustainability of the project.
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Child , Humans , Budgets , Congo , Cost-Benefit Analysis , Democratic Republic of the Congo , Malnutrition , Mortality , National Health Programs , Value of LifeABSTRACT
Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.
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PURPOSE: Proper management of nutrition or health care for pregnant women is known to have better perinatal outcomes for maternal and neonatal health. In this study, we investigated the effect of regular medical and nutritional counseling provided to pregnant women for improved-results for mother and neonates. METHODS: Thirty-five pregnant women participated in the study and received information on nutrition management via telephone or e-mail every four weeks until childbirth. The nutrition management program comprised proper diet, low-salt diet, low-sugar diet, breast-feeding preparation, and provision of a healthy menu according to their pregnancy trimesters. We categorized them by their degree of participation into a “low participation group” that formed the control group, and a “high participation group” as the study group. RESULTS: No significant differences were found in maternal age, and body mass index between the two groups at the time of enrollment in the study. Post-natal exclusive breast feeding rate was significantly higher in the high participation group (62%) than in the low participation group (32%) (p<0.05). In the neonatal results, gestational age at birth and neonatal birth weight were significantly higher in the high participation group than in the low participation group (p<0.05). Neonatal complication rate, neonatal admission rate to intensive care unit, rate of low birth weight, Apgar score at 1 and 5 minutes, as well as the rate of transient tachypnea were higher in the low participation group, but lacked any statistically significant difference. CONCLUSION: Collaborative nutrition management with obstetricians and nutritionists is helpful in achieving better perinatal outcomes.
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Female , Humans , Infant, Newborn , Pregnancy , Apgar Score , Birth Weight , Body Mass Index , Breast Feeding , Counseling , Delivery of Health Care , Diet , Diet, Sodium-Restricted , Electronic Mail , Gestational Age , Infant Health , Infant, Low Birth Weight , Intensive Care Units , Maternal Age , Mothers , Nutritionists , Parturition , Pregnancy Outcome , Pregnancy Trimesters , Pregnant Women , Tachypnea , TelephoneABSTRACT
The purpose of this study was to analyze the importance-performance of clinical nutrition management in convalescent hospitals. The research was carried out based on questionnaires administered from March to April, 2015 to 73 dietitians at 40 convalescent hospitals in the Gyeongnam area. There was a statistically significant difference between the mean scores for importance (4.01/5.00) and performance (2.95/5.00) of clinical nutrition management. The importance and performance grid analysis showed that participation in a nutritional management committee, administration of patients using a cooperation program among hospital departments, cooperation with a medical team on patient's nutrition status, nutrition initial assessment, nutrition care process for patients showing malnutrition, nutrition care process for tube feeding patients, management of a therapeutic diet, meal management using dietary slip instructions including a therapeutic diet, and explication of a therapeutic diet for patients scored high regarding importance and performance (doing great area). Medical records on patient's nutrition management, and nutrition counseling for requested patient scored low regarding the importance and high regarding performance (overdone area). Participation in medical rounds, personal nutrition education for patients, group nutrition education for patients, nutrition education for medical teams, development of a menu for therapeutic diet and standardized recipes, and provision of information on diet therapy for patients after discharge scored low regarding importance and performance (low priority area). Accreditation of convalescent hospitals and interest of medical professionals in clinical nutrition management were effective variables for the importance-performance gap of clinical nutrition management. In conclusion, the accreditation process and positive awareness of medical professionals with regard to clinical nutrition management had positive effects on reduction of the importance-performance gap in clinical nutrition management at convalescent hospitals. The strength of clinical nutrition management in the accreditation and development of an education program for increasing medical team or administrator interest in clinical nutrition management could lead to improvement of clinical nutrition management for elderly patients in convalescent hospitals.
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Aged , Humans , Accreditation , Administrative Personnel , Counseling , Diet , Diet Therapy , Education , Enteral Nutrition , Hospital Departments , Hospitals, Convalescent , Malnutrition , Meals , Medical Records , Nutrition Assessment , Nutritional Status , NutritionistsABSTRACT
Objective To investigate effect of standardized nutritional assessment, intervention, and monitoring on nutritional status of patients with cystic fibrosis (CF).Methods We recruited 6 consecutive patients with CF diagnosed from June 2005 to June 2015 in Peking Union Medical College Hospital, all given nutritional assessment and intervention.The clinical data and nutritional status of the patients were analyzed.Four cases were followed up, and their compliance and effect of nutritional intervention on their nutritional status were evaluated.Results The mean age of diagnosis of the patients was (19 ± 6) years.All the patients had recurrent onset of pulmonary infection and hypoxemia with varying degrees.The nutritional status was impaired in all the cases to different extent, with body mass index (BMI) of 3 patients under 20 years of age being lower than the third percentile of the standard growth curve for adolescents of the same age and sex.Mild microcytic hypochromic anemia existed in 2 cases, hypoalbuminemia in 2 cases (serum albumin ＜ 35 g/L in absence of liver or renal dysfunction), and decreased prealbumin level in 4 patients.The serum concentrations of Na, Cl, K, and Ca were approximately normal in all the 6 cases.Vitamin D level was detected in only 2 cases, all revealing vitamin D deficiency.High energy and high protein diet was suggested to all the patients, plus prescription of oral nutritional supplements for 5 patients.Diagnostic pancreatic enzyme replacement therapy (PERT) was performed in 3 patients who were suspected with exocrine pancreatic insufficiency (PI), together with fatsoluble vitamins supplementation including vitamin D3.Four CF patients were followed up for 11 to 39 months, of whom 1 was lost to follow-up after 11 months.During the follow-up period, 3 patients had progressive weight loss or growth retardation, and the other one patient failed to increase body weight.Dietary review of the 3 patients with available follow-up data revealed that actual energy intake and protein intake were only 46.1％-65.9％ and 44.1％-63.2％ of recommendation levels, respectively.By enhancing dietary education and guidance in follow-up, nutritional status of the patients was improved.Conclusion Intensive nutrition management, standardized nutritional intervention and monitoring, dietary guidance or enteral nutrition adjustment may constitute critical measures for improving nutritional status of CF patients.
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Objective To evaluate the effectiveness offour in onenutrition management mode in the treatment of type 1 diabetes mellitus (T1DM) in children. Methods Ninety children diagnosed with T1DM in Tianjin Children's Hospital were selected during March 2011 to June 2013. Segmented balanced random method was used to generate a random number timer, and the children were divided into intervention group and control group (n=45) by random letters. The patients in the intervention group were treated withFour in one nutrition management. Those in the control group were treated with traditional nutrition education method. Observation period was one year. The change of food choices of the parents was assessed before and after the intervention. Nutritional treatment compliance of children,fasting plasma glucose (FPG),2 hours postpransial glucose (2 hPG),and hemoglobin A1c (HbA1c) levels and complications, and so on were also evaluated. Results One year after intervention, the percentages of parents who chose low glycemic index food (41/45), vegetables and fruits consumed every day (40/45), often ate soy products(41/45), did not drunk carbonated drinks (43/45) of treatment group were significantly higher than those of control group (24/45, 20/45, 19/45, 26/45, P all<0.001);diet treatment compliance of children in treatment group was significantly better than that of the control group (P=0.000 2);FPG, 2 hPG, HbA1c of two groups of children decreased significantly than before. FPG[(8.11 ± 2.82) mmol/L], 2 hPG [(12.82 ± 1.05) mmol/L], HbA1c [(6.10±0.93)%] of treatment group were significantly lower than those of the control group [(11.71± 2.75) mmol/L, (13.77±1.49) mmol/L, (9.02±0.93)%;t=6.13, 1.66, 14.89;P<0.001 for all comparisons]. After treatment, 14 cases of treatment group had acute ketoacidosis and hypoglycemia , while 39 cases of control group had these complications (P=0.000 00). Readmission occurred in 11 cases of treatment group and 33 of the control group (P=0.000 00). Conclusions Four in onenutrition management mode was effective in the management of children with T1DM.
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Objective To observe the effect of the nutrition management according to the JCI(Joint Commission on Accreditation of Healthcare Organizations)management standard for critically ill pediatric patients with mechanical ventilation.Methods A total of 330 cases with mechanical ventilation were en-rolled in the control group from Hunan Province Children's Hospital PICU between Jan.2012 and Dec.2012, and these pediatric patients were managed with the conventional nutrient management.A total of 359 pediatric patients with mechanical ventilation were admitted to the experimental group from Jan.2013 to Dec.2013 and these patients were managed with nutrient management based on JCI standards.The length of mechanical venti-lation,stay in ICU,stay in hospital were compared between two groups,and the incidence of ventilator-associ-ated pneumonia,abandonment rate and mortality were also compared between experimental group and control group.Results The length of mechanical ventilation in control group[(8.39 ±1.34)days]was longer than that of experimental group[(5.69 ±1.12)days].The length of stay in PICU for control group[(12.32 ± 1.37)days]was more than that in experimental group[(9.42 ±1.53)days].The length of stay in hospital for control group [(15.37 ±2.16 )days]was higher than that of experimental group [(12.63 ±2.29 ) days].The incidence of ventilator-associated pneumonia(9.7%)in control group was higher than that of ex-perimental group,and the giving up or mortality rate in control group(8.48%)was higher than that of exper-imental group(4.35%).And there were significant differences by statistical analysis(P ﹤0.01 ,respective-ly).Conclusion According to the nutritional management in JCI standard,the length of mechanical ventila-tion,stay in PICU and stay in hospital time,the incidence of ventilator-associated pneumonia,and the aban-doned or mortality rate were reduced for critically ill pediatric patients with mechanical ventilation.
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PURPOSE: The aim of this study is to develop an evaluation tool for operation of food safety and nutrition education projects for middle class elderly using the concept of the balanced score card. METHODS: After the draft of the evaluation tool for the elderly training projects was completed, it was revised into the questionnaire and the validity of the indicators was tested by the Delphi group. The validity of the indicators was rated using a 5-point scale. The Delphi group consisted of 26 experts in the education sector, 16 government officials, and 24 professionals of the related area in communities. The first round test was conducted from July 9 to July 17, 2012, and 45 persons responded. The second round test was conducted from July 18 to July 25 and 32 persons responded. RESULTS: The indicators, which were answered by more than 75 percent of the experts as 'agree' (4 points), 'strongly agree' (5 point) were included as the final indicators for the evaluation tool: 28 items out of 36 in outcome perspectives, 9 items out of 12 in process perspectives, and 17 out of 20 items in structure perspectives. The score was allocated as 50 points for outcome indicators, 20 points for process indicators, and 30 points for structure indicators. CONCLUSION: Completion of the evaluation tool is a prerequisite to determine whether the program is effectively implemented. The monitoring tool developed in the study could be applied for identification of the most optimal delivery path for the food safety and nutrition education program, for the spread of the food safety and nutrition education program for middle class elderly.
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Aged , Humans , Education , Food Safety , Occupational GroupsABSTRACT
The increasing elderly population has created an urgent need for well-managed convalescent hospitals, which should provide appropriate clinical nutrition services. The new accreditation policy requiring participation of all convalescent hospitals since 2013 may promote improvement of clinical nutrition services. This study examined whether or not the accreditation policy has increased practice level and dietitians' perception of the importance of clinical nutrition management. Of the 177 convalescent hospitals accredited by January 30, 2014, dietitians from 73 hospitals (41.2%) completed the survey questionnaire. The pre-tested questionnaire surveyed general characteristics of the hospital and dietitians, current status of clinical nutrition management, and changes in the perception and practice levels of various aspects of food and clinical nutrition management. In average, dietitians with more than 5 years of work experience (68.1%) provided food and clinical nutrition services (71.2%). After accreditation, dietitians' perception of the importance and practice level of clinical nutrition service increased (P<0.001). Level of perception, however, was significantly (P<0.001) higher than practice level before and after accreditation. During perception and practice level of initial nutrition assessment, a compulsory accreditation item, notably and significantly (P<0.001) improved after accreditation. The significant difference between perception and practice level disappeared after accreditation. In conclusion, the accreditation process had positive effects on clinical nutrition management in terms of dietitians' perception and practice levels. Making more accreditation items compulsory and providing motivation and professional education to dietitians in convalescent hospitals could lead to additional improvements.
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Aged , Humans , Accreditation , Delivery of Health Care , Education, Professional , Hospitals, Convalescent , Motivation , Nutrition Assessment , Nutritionists , Surveys and QuestionnairesABSTRACT
OBJECTIVES: The purpose of this study was to develop web-based self-nutrition management u-Health program for diabetic patients (DMDMG: Diabetes Mellitus Dietary Management Guide) for achieving systematic self-management of diet. METHODS: The program consisted of five parts with different contents according to the results of needs assessment. Five major parts were 1) meal management part which contains calorie prescription, meals recording and dietary assessment, 2) prevention of disease part with information of diabetes and assessment of dietary behavior, 3) dietary behavior modification part with an education on dietary behavior modification plan and dietary behavior plan, 4) meal plan containing a training section for meal plan and self constructing part for meal planning by making tables, and 5) information about myself which composed with general and physical information. The system proposed in this study provides nutrients intake results right after input of diet intake, which is possible with simultaneous calculation of input data in the server with 3,495 food and 1,821 meal data base. The nutrients analysis program was evaluated with 26 diabetic patients with two-day 24 hr recall. RESULTS: The differences of nutrients intakes between DMDMG and CANPRO 3.0 ranged from 13.5-16.5%, which was caused by the differences of databases of the two programs. The characteristics of DMDMG were; 1) it can provide an interactive tailored nutrition management, 2) it is a practical tool of diabetes nutritional management, 3) the program gives motivation for the dietary behavior modification. CONCLUSIONS: The effectiveness of whole program needs to be conducted, but the program was an innovative tool for self-management of nutrient intakes, diet behaviors, meal management and tailored nutrition education.
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Humans , Behavior Therapy , Diabetes Mellitus , Diet , Education , Meals , Motivation , Needs Assessment , Prescriptions , Self CareABSTRACT
The purpose of the study was to examine nutritional management and nutritional care demands of home-visit care service and the nutritional status of serviced elderly. The survey was carried out from 5th to 21st of January, 2011 among 37 In-Home Service institutions. The number of elderly surveyed by 143 care helpers was 281. Analysis was performed for 203 subjects (male: 44, female: 159). The age distribution was from 50 to 99 years. The grading by long-term care insuranceshowed 18,2% on level 1 and 2, and 81.8% on level 3. For the disease treatment, the proportion of implementing diet treatment turned out to be very low. The proportion of subjects living with their children was 45.3%, and living alone was 29.1%. The proportion of home-visit care among types of In-Home Service was 70%. Subjects who needed additional necessary diet management service turned out to be 40.9%. Diet management was the most necessary services from all levels. MNA (specifiy MNA) scores were significantly (p < 0.001) associated with BMI, mid-arm circumference (MAC), calf circumference (CC), intake problems, and weight loss during the last 3 months. For studied elderly, 45.3% were malnourished, and 46.8% were at the risk of malnutrition by MNA score. Based on the result of this survey, the nutritional care was not systematic on the In-Home Service. Prevention and management of the disease was much better than the treatment to improve the quality of life. We conclude that nutrition management is necessary for the elderly. To improve nutritional status of elderly in home care services, systematic nutrition management should be implemented.
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Aged , Child , Humans , Age Distribution , Diet , Home Care Services , House Calls , Insurance, Long-Term Care , Long-Term Care , Malnutrition , Nutrition Assessment , Nutritional Status , Quality of Life , Weight LossABSTRACT
The purpose of this study was to evaluate the current state of foodservice and clinical nutrition management in a hospital-based nutrition department. Nutritional guidelines and survey reports of hospital evaluation programs from 2004 to 2009 were analyzed. In total, 275 hospitals in the first period and 288 hospitals in the second period were evaluated. The division of knife and chopping board use decreased from 97.2% in 2005 to 89.7% in 2008, the maintenance of a proper freezer temperature (below -18degrees C) increased from 82.1% in 2004 to 97.7% in 2007 (88.9% to 97.4% from large hospitals and 69.8% to 86.5% from small/medium hospitals in 2005 and 2008, respectively). In tube-feeding management, the performance rate of material cold storage and the offer rate of tube-feeding were 65.9% and 94.2% in 2007, respectively. The cold storage of material, proper use within 24 hours after opening or production, and the use of an appropriate label were 47.3%, 71.2% and 67.2% in 2009, respectively. The rate of a management system for undernourished patients was 86.0% in 2007 (56.4% for large hospitals, 18.9% for small/medium hospitals) and 14.3% in 2009. In standards of nutrition support management, the performance rates of constructing a nutrition support team, the nutrition support team activity, and organizing multidisciplinary team were 66.7%, 43.6%, and 64.1% respectively, in 2004. For large hospitals, those rates were 61.1%, 36.1%, and 58.3%, in 2005, 93.0%, 62.8%, and 91.9% in 2007, and 69.2%, 43.6%, and 69.2% in 2008, respectively. The results of this study suggest standards on sanitary foodservice preparation, production, and tube-feeding production need to correspond with HACCP regulations for small/meidium hospitals in standards of a healthcare accreditation system. It will be necessary to understand the operating conditions of nutrition departments in convalescent hospitals, psychiatric hospitals, and geriatrics hospitals. As the application of accreditation is required from 2013, standards will need to be improved and continuously updated for healthcare accreditation.
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Humans , Accreditation , Delivery of Health Care , Geriatrics , Hospitals, Convalescent , Hospitals, Psychiatric , Social Control, FormalABSTRACT
ADA's Nutrition Care Process (NCP) is defined as "a systematic problem-solving method that dietetics practitioners use to critically think and make decisions to address nutrition-related problems and provide safe, effective, high quality nutrition care." The NCP is a standardized process not standardized care. The NCP consists of four distinct but interrelated steps: (1) nutrition assessment, (2) nutrition diagnosis, (3) nutrition intervention, and (4) nutrition monitoring and evaluation. The second step, nutrition diagnosis, is the newest addition to the nutrition care process. The desired format for writing a nutrition diagnosis is a PES (problem, etiology, and signs and symptoms) statement. Nutritional management for diabetes patients is conducted differently by each registered dietitian and medical institution. If a nutritional diagnosis is identified by nutrition assessment in diabetes patients and the accompanying process, which includes implementation of nutrition intervention and monitoring and evaluation of the results of intervention, is standardized, high quality nutritional management through standardized language and documentation is expected to result.