Length of Hospital Stay and Its Associated Factors among Surgical Patients in Hospital Serdang

@#Introduction: Hospital length of stay (LOS) is one of the measurable indicators which can be used to evaluate hospital administration, operative performance, and quality of patient care. Prolonged LOS has been associated with poor outcomes in patients and inefficient use of hospital resources. Due to the scarcity of findings in this field in Malaysia, this study aims to identify the factors affecting LOS. Methods: A single health facility-based retrospective cross-sectional study was conducted in Hospital Serdang. Data of patients admitted to the surgical ward from 2017 to 2021 were retrieved. Result: A total of 114 surgical patients’ data were analysed, of which most were adults (72.8%), female (69.3%) and Malay (67.5%). The mean LOS was 5.90 ± 4.35 days. Pearson correlation revealed age (r = 0.309, p = 0.001) and preoperative albumin (r = -0.397, p <0.001) having a significant correlation with LOS. An independent samples T-test showed that males had significantly higher mean LOS than females (t = 2.653, p = 0.009). Surprisingly, having been seen by dietitians and being supplemented by oral nutrition supplements (ONS) had longer stay compared to groups who were not seen by dietitians and given ONS respectively (t = 4.278, p<0.001), (t = 3.111, p = 0.002). Furthermore, those with a moderate and high risk of malnutrition spent approximately 3.27 days longer hospitalized than low-risk patients (t = -2.868, p = 0.007). Conclusion: Factors that influence LOS are age, gender, preoperative albumin, seen by a dietitian, risk of malnutrition and oral nutrition supplementation.

Analysis of the registered dietitian competence assessment examination during 2017-2021 in China / 中华临床营养杂志

Objective:To analyze the competence assessment examinations of registered dietitians in China during 2017-2021 to inform the training of dietetic professionals.Methods:A systematic review was conducted about the composition and changing trends of examination participants during 2017-2021. Participants were divided into subgroups based on gender, age, education, professional background and affiliations and the qualification rate was compared across different subgroups.Results:The number of examination participants showed an increasing trend overall, with the majority being females and aged 26-35 years. The ratio of participants with bachelor's: master's: doctor's degree was about 15: 9: 1. The proportion of participants majoring in nutrition science decreased from 32.1% to 20.3%, while that of participants majoring in other medical and food sciences increased. Among participants from healthcare institutions, a decreasing proportion of participants were with a major in nutrition science, while this proportion among participants from companies were stable at 38.8% to 50.2%. The average qualification rate was 35.7%, showing no significant differences among different gender and age groups. But the qualification rate varied significantly across subgroups with different education level, professional background, and affiliations ( P < 0.05). Subgroups with more advanced degrees showed higher qualification rate and the best rate was observed in the subgroups with professional background in nutrition science and from nutrition-related institutions. Conclusion:The training of dietetic professionals in China should be improved, lifelong learning should be promoted in nutrition practitioners, and the sustainable development of dietitians should be impelled.

Nutrition Counseling in an Academic Medical Center According to Socioeconomic Status and Grocery Shopping Consumer Behavior Decreased Relative Fat Mass in Breast Cancer Survivors

ABSTRACT Background: Body composition assessment in breast cancer survivors (BCSs) is essential to plan feasible dietary strategies for sarcopenic obesity prevention. Objective: Studying the effect of an individualized nutrition intervention according to socioeconomic status and grocery shopping behavior on BCSs relative fat mass (RFM). Methods: BCSs attending an academic medical center were studied; participants saved all 1-week supermarket tickets and answered a grocery shopping consumer preference survey. RFM was assessed at baseline and after the 3-month nutrition intervention. Nutrition plans were based on the dynamic macronutrient meal-equivalent menu method (MEM) and dietary guidelines for BCSs. Results: Thirty-three BCSs completed the study and 91% of them presented obesity or overweight at baseline. After the intervention, BCSs lost 1.6 kg (p < 0.01) of body weight, 1.8 kg (p < 0.01) of RFM, 3 cm (p < 0.01) of waist circumference, and 2.4 cm (p < 0.01) of hip circumference, while no changes were observed in fat-free mass (p = 0.6) and arm bone-free muscle area (p = 0.7). Conclusions: RFM and body weight in breast cancer survivors decreased after an individualized nutrition intervention according to socioeconomic status and grocery shopping consumer behavior. Based on the participants’ food preferences and consumer behavior, plant-based protein diet plans cost less than the animal-based protein diet plans.

Management Responsibilities Among Dietitians: What is the Level of Job Satisfaction and Skills Involved? A Scoping Review

@#The role of dietitians involves not solely on clinical responsibilities. Additionally, operation management responsibilities such as managing human labor, financial resources, and problem solver are the tasks that a dietitian look after. It is reported to be challenging and stressful and could affect job satisfaction levels in the working environment. This scoping review aimed to explore the job satisfaction level and skills needed among dietitians to assume management responsibilities at their workplace. This study was completed using PRISMA guidelines. Online databases (Scopus and Science Direct) were used to identify papers published from 2000 to 2019. We selected English publications from the United States, Australia, South Africa, Korea, and the United Kingdom that used job satisfaction as a primary or secondary outcome. Studies were included if they addressed dietitians who were involved in clinical work, food service, and management in their dietetic practices. Findings on existing skills, including managerial skills, communication, teamwork, and time management among dietitians with management responsibilities, have helped to enhance the job satisfaction and work quality of the dietetic profession. The findings would be useful for human resource management in the organisation, preserving the professional identity of a dietitian.

Impact of Dietitian Delivered Intensive Nutrition Intervention on Dietary Intake and Weight Outcome Among Gynecology Cancer Outpatient Prior to Surgery

@#Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.

Nutritional Education for Patients Undergoing Bariatric Surgery Improves Knowledge of Post-Bariatric Dietary Recommendations

Objective: The short and long-term success of bariatric surgery is determined by patient adherence to post-operative dietary recommendations. Nutritional education programs are reported to be effective in increasing patient adherence to dietary recommendations. The aim of this study was to assess the effect of nutritional education on nutritional knowledge related to post-bariatric dietary recommendations on Saudi bariatric patients and the impact of time on their knowledge retention following the education. Methods: In this repeated measure pre- to post-intervention study, 55 patients (19 male, 36 female), aged between 20-65 years, were recruited from the Surgical Clinics at King AbdulAziz University Hospital in Jeddah, Saudi Arabia. Patients were asked to complete an Eating after bariatric surgery (EABS) questionnaire before receiving nutritional education and three times after the education: immediately and at one and three months post-nutritional education. Results: The nutritional knowledge of patients, measured by EABS, improved significantly (p<0.001) after the educational session; however, total scores after one and three months showed no significant improvement in knowledge compared to the pre-educational period. Hence, nutritional education improved post-bariatric nutritional knowledge in bariatric patients in the short-term; however, this nutritional knowledge was not retained after one to three months. Conclusion: We conclude that it is important for nutritional education to be delivered prior to surgery, with ongoing follow-up after surgery, to improve the long-term adherence of patients to dietary recommendations.

Evaluación del nivel de participación del nutricionista en la prescripción dietética en hospitales públicos y privados de Chile / Evaluation of Clinical Dietitian Participation in Adequate Prescription of Dietary Indications in Public and Private Hospitals in Chile

Antecedentes: actualmente, Chile tiene un déficit de dietistas clínicos y se desconoce si este déficit está afectando la prescripción de indicaciones dietéticas adecuadas para pacientes hospitalizados. Objetivo: evaluar el nivel de participación del nutricionista clínico en la prescripción dietética en los hospitales públicos y privados del territorio nacional, entre los meses de agosto y octubre del año 2016. Materiales y métodos: estudio exploratorio, descriptivo; se invitaron a participar a 360 nutricionistas, contestaron 110 nutricionistas clínicos. Se aplicó un cuestionario de 21 preguntas, enviado vía correo electrónico. Resultados: las horas diarias dedicadas al servicio clínico presentaron una mediana de 6 horas, el 41,8 % de los encuestados tenía entre 26 y 50 pacientes a su cargo. El 99 % de los nutricionistas puede sugerir cambios en la prescripción dietética; sin embargo, un 45 % de las sugerencias realizadas al médico para modificar regímenes son registradas siempre en la ficha clínica. La participación en la prescripción dietética al inicio del tratamiento corresponde a un 9,1 %, en la evolución es de un 32,7 % y en la prescripción realizada al alta es de un 56,4 %. A más años de experiencia y más horas dedicadas al servicio se presenta un significativo mejor puntaje en la prescripción dietética (p<0,05). Conclusiones: el nivel de participación del nutricionista clínico es medio, los nutricionistas con más años de experiencia y mayor número de horas dedicadas a los pacientes presentan mayor prescripción dietética.

Background: Currently Chile has a deficit of clinical dietitians and it is unknown if this deficit is affecting the prescription of adequate dietary indications to hospital patients. Objective: Evaluate the participation level of clinical dietitians in the adequate prescription of dietary indications in public and private hospitals nationally, between August and November 2016. Materials and Methods: Exploratory descriptive study. 360 dietitians were invited to participate, and 110 accepted. A 21-question self-response questionnaire was sent to participants via email. Results: Daily hours dedicated to clinical services was a median of 6 hours among participants, 41.8% of whom had between 26 and 50 patients in their care. 99% of the dietitians are able to suggest changes to the dietary prescriptions; however only 45% of the modifications that are suggested to the doctors are ever recorded in the clinical records. Participation in dietary prescription at the beginning of patient treatment is 9.1 %, throughout the hospital stay is 32.7 %, and prescriptions made at discharge correspond to 56.4 %. More years of experience and more hours dedicated to clinical service correspond to a significantly better percentage in dietary prescriptions administered (p<0.05). Conclusions: The level of dietitian participation is average; the dietitians with more years of experience and higher number of hours dedicated to patient care present better dietary prescription to hospital patients.

Impact of Professional Nutrition Education on Dietary Behavior and Body Mass Index Status of Senior Clinical Nutrition Students and Dieticians in Saudi Arabia

Background: Dieticians are uniquely qualified to providenutrition education that can promote healthy lifestyles, reducethe burden of diet related chronic diseases, and improve thequality of life among population.Objectives: To evaluate the effectiveness of professionalnutrition education on changing dietary habits and achievementof normal BMI.Methodology: A cross sectional study. Subjects weregraduates from clinical nutrition departments and otherdepartments of Saudi Universities (n=225). Using internetstructured questionnaire focusing on dietary habits before andafter college education, physical activity and weight changes totest the impact of education on food habits both on the subjectand his/her surrounding environment (family and friends).Results: Increase consumption of fruits, vegetables, darkgreen vegetables, whole grain cereals, dairy products, andwater and increase physical activities, in addition to decreaseconsumption of soda, artificial canned juices, energy drinks,solid fat, added sugar, saturated fat and salt were clear amonggraduates of clinical nutrition departments in comparison toother graduates.Conclusion: Professional nutrition education positively impactfood choices and healthy food habits. This impact is extendedto their families and friends.

Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet

BACKGROUND/OBJECTIVES: The objective of this study was to assess the level of awareness, comfort, and likelihood of liberalizing the hemodialysis diet in practicing renal registered dietitian nutritionists (RDN). SUBJECTS/METHODS: An original, cross-sectional survey was sent to the Academy of Nutrition and Dietetics' Renal Practice Group in May 2017, consisting primarily of renal dietitians. RESULTS: A total of 187 renal dietitians responded to the survey designed to assess their current practices regarding the renal diet for hemodialysis patients and how comfortable they would be liberalizing the current restrictions. On average, 16.3% of dietitians are extremely likely to liberalize the restrictions on various food groups including fruits and vegetables, beans and legumes, and whole grains. CONCLUSIONS: RDN feel confident in their ability to interpret and apply evidence-based literature into practice, and they are moderately comfortable liberalizing the renal diet. The participants were generally more comfortable liberalizing the phosphorus restriction than the potassium restriction, and the sodium restriction remains important to control interdialytic weight gain and hypertension. Future research is needed to establish efficacy of a liberalized diet as well as interventions to help RDN feel more comfortable implementing a liberalization of the renal diet.

Analysis of the Participation Reasons and Deterrents on Welfare Facility Dietitians for the Elderly / 대한지역사회영양학회지

OBJECTIVES: This study analyzed the education participation reasons and deterrents of dietitians who work in welfare facilities for the elderly. METHODS: The survey was completed by 144 dietitians working at welfare facilities for the elderly in Korea. The survey was conducted in October, 2018, both on-line and off-line, based on the demographic characteristics, work status on welfare facilities for the elderly, Participation Reasons Scale (PRS) and Deterrents to Participation Scale (DPS-G). The data were analyzed using frequency analysis, descriptive analysis, factor analysis, reliability analysis, regressive analysis using SPSS ver. 25.0. RESULTS: The reason for participation were divided into three factors: ‘Responsibility of professional and self-development (5.76 ± 1.04)’, ‘Job stability and personal benefits (4.98 ± 1.28)’, and ‘Interaction and development of professional competencies (5.85 ± 1.00)’. ‘Interaction and development of professional competencies’ was the highest motivation factor. Also, the deterrents for participation were divided into four factors: ‘Dispositional barrier (2.70 ± 1.29)’, ‘Dissatisfaction of education usability (3.39 ± 1.38)’, ‘Institutional barrier (4.21 ± 1.45)’, and ‘Situational barrier (2.36 ± 1.30)’. ‘Institutional barrier’ showed the highest deterrents factor. In addition, ‘Responsibility of professional and self-development’ and ‘Interaction and development of professional competencies’ were negative attributes for ‘Dispositional barrier’ (p<0.001). CONCLUSIONS: These results provide basic data to promote participation in education and contribute to the improvement of their job ability and education capacity of the food and nutrition management of welfare facilities for the elderly

Analysis of the Participation Reasons and Deterrents on Welfare Facility Dietitians for the Elderly / 대한지역사회영양학회지

OBJECTIVES: This study analyzed the education participation reasons and deterrents of dietitians who work in welfare facilities for the elderly. METHODS: The survey was completed by 144 dietitians working at welfare facilities for the elderly in Korea. The survey was conducted in October, 2018, both on-line and off-line, based on the demographic characteristics, work status on welfare facilities for the elderly, Participation Reasons Scale (PRS) and Deterrents to Participation Scale (DPS-G). The data were analyzed using frequency analysis, descriptive analysis, factor analysis, reliability analysis, regressive analysis using SPSS ver. 25.0. RESULTS: The reason for participation were divided into three factors: ‘Responsibility of professional and self-development (5.76 ± 1.04)’, ‘Job stability and personal benefits (4.98 ± 1.28)’, and ‘Interaction and development of professional competencies (5.85 ± 1.00)’. ‘Interaction and development of professional competencies’ was the highest motivation factor. Also, the deterrents for participation were divided into four factors: ‘Dispositional barrier (2.70 ± 1.29)’, ‘Dissatisfaction of education usability (3.39 ± 1.38)’, ‘Institutional barrier (4.21 ± 1.45)’, and ‘Situational barrier (2.36 ± 1.30)’. ‘Institutional barrier’ showed the highest deterrents factor. In addition, ‘Responsibility of professional and self-development’ and ‘Interaction and development of professional competencies’ were negative attributes for ‘Dispositional barrier’ (p<0.001). CONCLUSIONS: These results provide basic data to promote participation in education and contribute to the improvement of their job ability and education capacity of the food and nutrition management of welfare facilities for the elderly

Food Allergy-related Awareness and Performance of Dietitians at Children's Hospitals in Korea: Comparison of Certificate Possession among Clinical Dietitians / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to examine the food allergy-related knowledge, awareness, and performance of dietitians at children's hospitals, depending on whether or not they have a clinical dietitian certificate.METHODS: A questionnaire survey was administered to 41 dieticians at children's hospitals registered as a part of the Korean Hospital Association. The survey consisted of questionnaires examining general characteristics, nutritional counseling-related characteristics, and food allergy-related characteristics (food allergy-related knowledge, awareness, and performance). We examined differences according to the status of clinical dietitian certification.RESULTS: The proportion of subjects who were holders of clinical dietitian certificates was 48.8%. There were differences between holders of clinical dietitian certificates and non-holders as follows. Regarding nutritional awareness and performance, ‘needs to provide nutrition counseling in children's hospitals’, ‘providing nutrition counseling services in working hospitals’, and ‘whether there is a nutrition counseling room’ scored higher among holders of clinical dietitian certificates than non-holders. Holders of clinical dietitian certificates showed higher scores for knowledge of food allergy symptoms and food allergy management than non-holders. For food allergy awareness and performance, ‘self-assessment of food allergy knowledge understanding level’, ‘awareness of open oral food challenge (OFC)’, ‘recognition of the need for education and counseling on food allergy for patients/guardians’, and ‘food allergy related educational experience’ scored higher among holders of clinical dietitians certificates than in non-holders.CONCLUSIONS: Children's hospital dietitians with a clinical dietitian certificate showed high knowledge, awareness, and performance related to food allergies. It is thus necessary to employ a clinical dietitian for food allergy management in children's hospitals. In addition, training and conservative education are necessary for the management of food allergies for children's hospital dietitians.

Clinical audit on adherence to using Malnutrition Screening Tool and dietitian referral in the Oncology Outpatient Clinic, National Cancer Institute, Malaysia

@# Introduction: Malnutrition is a frequent complication in cancer patients and can negatively affect treatment outcome. Preliminary audit conducted at the Oncology Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of dietitian referrals were recorded. This audit aims to determine the rate of adherence to nutritional screening, and to implement remedial measures for improved patient care. Methods: This was a cross-sectional audit comprising three phases, namely initial audit, remedial measures and re-audit. Criteria audited include screening rate using MST and dietitian referral based on MST scores. Standards were set at 100% for both criteria. Data collected for initial audit were patients’ MST scores records and total dietitian referral forms retrieved from Electronic Medical Records. After initial audit, self-administered questionnaires for nurses and physicians were developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate referral. After 6 months, a re-audit was conducted. Results: Total subjects for initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit showed screening rate using MST increased significantly from 6.3% to 79.5%, but there was no significant change for the dietitian referral rate. Conclusion: This clinical audit has led to a change in the policy in NCI outpatient clinics whereby nurses directly schedule dietitian referrals without going through physicians for patients with MST scores ≥2. Continuous audit and monitoring are necessary to facilitate improvement in MST implementation for better outpatient care.

Use of Dietary Management in Irritable Bowel Syndrome: Results of a Survey of Over 1500 United States Gastroenterologists

BACKGROUND/AIMS: Dietary therapy is increasingly used to manage gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). We aim to gauge United States gastroenterologists’ perceptions of dietary therapies for IBS. METHODS: We distributed a 22-question survey to members of the American College of Gastroenterology. The survey was developed by gastroenterologists and survey methodologists. We collected information pertaining to demographics, providers’ interpretation of their patients’ views on dietary therapy, and gastroenterologists’ perceptions on dietary therapy, and nutritional counseling in IBS. RESULTS: One thousand five hundred and sixty-two (14%) surveys were collected. Nearly 60% of participants reported that patients commonly associate food with GI symptoms. IBS patients most commonly use a trial and error approach followed by a lactose-free and gluten-free diet, and rarely use a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet on their own. Over half of providers recommend diet therapy to > 75% of IBS patients and most commonly recommend a low FODMAP diet. Only 21% of gastroenterologists commonly refer IBS patients to registered dietitians, and only 30% use GI dietitians. Female providers were more likely than males to recommend dietary changes as the primary mode of therapy (OR, 1.43 [1.09–1.88]; P = 0.009). CONCLUSIONS: Our national survey identified enthusiasm for diet treatment of IBS. While patients infrequently tried a low FODMAP diet on their own, GI providers commonly recommended this diet. Only a minority of GI providers refer their IBS patients to a registered dietitian for nutrition counseling and few refer patients to dietitians with specialized GI training. Female providers were more enthusiastic about diet therapies than males.

Applicability Evaluation of Job Standards for Diabetes Nutritional Management by Clinical Dietitian

This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. ‘Nutrition intervention’ was 4.5 ± 0.5 for task importance, ‘nutrition assessment’ was 4.0 ± 0.7 for performance, and ‘nutrition diagnosis’ was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were ‘checking basic information,’‘checking medical history and therapy plan,’‘decision of nutritional needs,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’ The tasks with high importance but low performance were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘monitoring of nutrition intervention process.’ The tasks of both high importance and high difficulty were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘supply of foods and nutrients,’‘education of nutrition and self-management,’ and ‘monitoring of nutrition intervention process.’ The tasks of both high performance and high difficulty were ‘documentation of nutrition assessment,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’

Effect of Dietitian's Perceived Organizational Culture on Organizational Commitment at Hospital Foodservices

This study was conducted to investigate the effect dietitians' perceived organizational culture has on organizational commitment at hospital foodservices. A total of 382 dietitians working at general hospitals with 500 beds or more participated in the survey from January 16 to February 8, 2017. The result of perceived organizational culture showed hierarchical culture, rational culture, development culture, and group culture scored to be 5.29, 5.25, 5.15, and 4.97 out of 7, respectively. Differences in the perception of organizational culture and organizational commitment were observed according to the general demographics of subjects, but no significant differences were shown according to the general characteristics of hospitals. For organizational commitment perception, affective commitment (5.14), normative commitment (4.41), and continuance commitment (4.21) were identified. There were differences according to age, work experience at the present job, position, and education level by type of organizational culture. In terms of organizational commitment, there were significant differences in age, work experience at the present job, employment status, and possession of clinical dietitian certificate, position by type of commitment. A positive correlation between dietitians' perceived organizational culture and organizational commitment such as overall organizational commitment, affective commitment, and normative commitment was observed (P<0.01). Group culture, development culture, and hierarchical culture positively affected overall organizational commitment (P<0.001). Development culture, group culture, and hierarchical culture had positive effects on affective commitment, whereas rational culture had a negative influence. Development culture (P<0.05), group culture (P<0.001), and hierarchical culture (P<0.01) positively influenced normative commitment. Results suggest that it is necessary to develop plans for the improvement of rational culture, group culture, and development culture at hospital foodservice organizations.

Needs for clinical dietitian in hospital settings: Importance of doctor's awareness regarding clinical nutrition service as mediating variable / 한국영양학회지

PURPOSE: The purpose of this study was to explore whether or not there is a relationship between doctor's awareness of clinical nutrition service and needs for a clinical dietitian. METHODS: A cross-sectional survey design was used. The research was carried out by using questionnaires that had been specifically designed for the study. The research was conducted from September to October, 2013 for 311 doctors at 43 hospitals (with over 400 beds). Frequency analysis, factor analysis, reliability analysis, confirmatory factor analysis, and bootstrapping analysis were conducted using SPSS 21.0. RESULTS: ‘Implementation of clinical nutritional service’ (p < 0.001) and ‘usefulness on clinical nutrition service’ (p < 0.001) were found to be correlated with ‘importance of clinical nutrition service’ as an independent variable. The correlation between ‘importance of clinical nutrition service’ as a mediating variable and ‘needs for clinical dietitian’ as a dependent variable was also confirmed (p < 0.001). The results of the bootstrapping test showed that the mediating effect of ‘importance of clinical nutrition service’ was significant. The indirect effect value between ‘implementation of clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.040, indirect effect value between ‘usefulness on clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.095. CONCLUSION: The frequency of providing clinical nutritional services, the quality of clinical nutritional services, and the degree of implementation of clinical nutritional services were found to be important for positive perception of clinical nutrition services by doctors. Therefore, proper provision of clinical nutrition services and effective therapeutic effects will be continuously highlighted, which will increase the awareness of the physician and ultimately increase the demand for clinical nutrition service.

An analysis on the candidate profile and pass rate of the pilot qualification examination for registered dietitians in Shanghai / 中华临床营养杂志

Objective To investigate the candidate profile and pass rate of the 2016 pilot qualification examination for registered dietitians in Shanghai,and attempt to inform the improvement of the examination.Methods An analysis was conducted on the profiles of all the 193 qualified candidates in the signing-up system of the 2016 pilot examination.Questionnaire surveys were carried out to collect feedback from the candidates on the enrollment requirements of the examination.The pass rates were compared between subgroups divided by age,gender,education,major,workplace (as employee or intern),working years and academic rank.Results 81.3％ of the candidates were aged between 20 and 29.Females accounted for 80.3％.The candidates had all received bachelor's degree,75.6％ from full-time undergraduate programs and 96.4％ from programs of nutrition.78.3％ of the candidates rated the enrollment requirements of the examination as "reasonable" or "relatively reasonable".The overall pass rate of the examination was 38.3％.The pass rate of the examinees working or doing internship in hospitals (45％) was significantly higher than that of others (24.5％) (P=0.012).Conclusions The overall pass rate is reasonable.Examinees working or doing internship in hospitals had a higher pass rate than those working in other places.The majority of the candidates had bachelor's degree of nutrition,which is in accordance with the requirement of similar exams in other parts of the world.

Comparison Study on Perception of Job Importance, Job Performance, and Job Difficulty in Clinical Dietitians at Small and Medium Hospitals in Busan

This study aimed to compare perception of job importance, job performance, and job difficulty between clinical dietitians working at small and medium hospitals in Busan. The survey was conducted from July 15 to August 31, 2014, and data were analyzed using the SPSS program. The mean scores for perception of job importance, job performance, and job difficulty of clinical dietitian's task elements were 3.88, 2.87, and 3.18 out of 5.0, respectively. Perception of job importance had a positive relationship with job performance. However, job performance showed a negative relationship with job difficulty. There were strong positive relationships among nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring & evaluation, nutrition research in perception of job importance (P<0.05, P<0.01). Nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition research showed positive relationships with job performance (P<0.05, P<0.01). There was also a positive relationship among clinical dietitian's task with job difficulty (P<0.05, P<0.01). These results suggest that it would be effective to adopt training programs for appropriate nutrition service and to provide continuous education programs for professional development.

Development and evaluation of continuing education course in renal nutrition

BACKGROUND/OBJECTIVE: Competent renal dietitians are crucial for better patient compliance and clinical outcomes, specifically in critical settings. The aim of this study was to develop and evaluate an evidence-based course in renal dietetics for dietitians working in health care systems where dietetic specialization is absent. SUBJECTS/METHODS: Fifteen licensed dietitians working with hemodialysis patients in Lebanon were randomly recruited to participate in the course. The latter was developed by the study's primary investigator, according to evidence-based practice guidelines, and focused on all aspects of renal nutrition. Total course duration was 28 hours spread over a 2 month period. Dietitians' knowledge in renal nutrition was tested pre- and post-training through a 23-item questionnaire; the total score was expressed in percentage (< 60% score indicated insufficient knowledge). Paired-samples t test was used for statistical analysis. RESULTS: Overall knowledge of the dietitians significantly improved post-training and reached satisfactory levels (pre: 38.75 +/- 17.20%, post: 62.08 +/- 21.85%). Sub-analysis of the change in the knowledge showed significant and satisfactory improvement only in 3 topics: 1) correct body weight use in calculations, 2) energy estimation method and 3) phosphorus management. Knowledge in the fluid management significantly improved but did not achieve a satisfactory level. CONCLUSION: The course significantly improved dietitians' knowledge in renal nutrition. If adopted as part of the continuing education of dietitians in countries that lack dietetic specializations, it may serve the first step towards improving health care practice.