Clinical dietetics changes due to cost-reduction activities in healthcare systems.

OBJECTIVE: This study was designed to assess changes in clinical dietetics due to cost-reduction activities in healthcare systems. SUBJECTS: 1,200 ADA members who indicated that they were employed by acute care hospitals in ADA Area 2 states. DESIGN: A questionnaire about changes in clinical dietetics staffing and clinical dietitians' activities and responsibilities was developed based on qualitative research. Descriptive statistics, t tests, analysis of variance, chi2 tests, and correlations were calculated. RESULTS: A total of 342 usable questionnaires (28.5%) were returned. More than one third (37.9%) of respondents reported reductions in the number of clinical dietitians, and 32.2% reported increases in the number of part-time clinical dietitians. Most respondents indicated that they were more involved with high-risk patient interventions, had limited time for inpatient instruction, and experienced an increased patient caseload. Although 45.4% of respondents reported diminished job satisfaction due to recent changes in healthcare systems, some changes, such as increased high-risk patient intervention and referrals, were positively correlated with perceived job satisfaction. DISCUSSION: Thorough review of current clinical dietetics activities/responsibilities and planning before cost-reduction, restructuring activities may maximize staff utilization without decreased job satisfaction of clinical dietetics staff.

Improving dietetics education with interactive communication technology.

Changes occurring in health care, education, and technology are altering dietetics education. A model of learnercentered, cooperative, distance education based on interactive online technology is described for use in a dietetic internship. Evaluation of this model includes review of key-feature exams, results of computer attitudes surveys, use of the technology by interns, exit interviews, and performance on the examination for registered dietitians. In a pilot study of the model with 8 subjects, comfort using the Internet improved significantly. Use of interactive communication technology in dietetics education has the potential to improve competency, technological aptitude, professional partnering skills, and lifelong learning skills.

Growth patterns and nutritional factors associated with increased head circumference at 18 months in normally developing, low-birth-weight infants.

OBJECTIVE: To identify patterns of growth, nutrition practices, and feeding behaviors associated with normal Denver II developmental screening results at 18 months of age. DESIGN: A retrospective review of hospital medical charts was conducted to collect discharge diagnosis and dietary data. Developmental clinic charts were reviewed to collect growth and diet data, Denver II results, and medical data from 4-, 9-, and 18-month visits. SUBJECTS/SETTING: Twenty-eight children were identified from a review of developmental clinic records in a midwestern children's hospital. Criteria were single or twin birth, birth weight of 2,000 g or less, follow up at the hospital developmental clinic, and completion of 3 screening visits. STATISTICAL ANALYSES PERFORMED: National standards were used to calculate z scores. Patterns of growth were analyzed using analysis of variance. Stepwise forward linear regression analysis was done to construct a model predicting head circumference at 18 months of age. RESULTS: Significant catch-up growth (P = .0006) occurred as length z score increased from -0.87 at 4 months of age to -0.45 at 18 months. A regression model predicting head circumference at age 18 months was developed that included nutrition and growth variables such as head circumference at 9 months, type of parenteral amino acids administered in the hospital, z score of weight at 4 months' adjusted age, and time of first enteral feeding. APPLICATIONS: Interventions designed to support breast-feeding in the hospital and at home are indicated as is increased emphasis on monitoring growth. Delays in growth need to be treated aggressively; for example, nutrition interventions should begin by the age of 4 months if weight gain is not appropriate.

Fiber-optic pressure sensors for internal combustion engines.

Two designs incorporating embedded fiber Fabry-Perot interferometers as strain gauges were used for monitoring gas pressure in internal combustion engines. Measurements on a Diesel engine, a gasoline-fueled engine, and a natural-gas engine are reported.

Beliefs about and usage of vitamin/mineral supplements by elderly participants of rural congregate meal programs in central Iowa.

Responses to the belief statements indicated that elderly subjects who used supplements, either appropriately or inappropriately, had more misperceptions about vitamin/mineral supplements than elderly subjects who did not use supplements. These results indicate that the elderly need guidance from dietitians or other qualified health professionals to make informed choices on whether to take vitamin/mineral supplements. Those elderly persons who choose to use supplement products also need guidance in terms of safety and cost.

Follow-up study of recent graduates: the value of death education in their curriculum.

Graduates from three coordinated dietetics programs who had participated in a research project in which a death education curriculum unit for dietetic students was developed, implemented, and evaluated, were mailed questionnaires to ask their opinion of their undergraduate preparation to work with terminally/seriously ill clients. Graduates agreed that including death education was important in their preparation as dietitians and suggested expanding the topics. For the subjects in this sample, neither death education as a student nor work experience with the dying since graduation has changed their attitude score on three scales: Death Fear, Disengagement from Death Fear, and Dietetic Attitude. Although this is a very small sample, the findings suggest that attitudes about death and working with the dying are resistant to change. Members of this group, both as students and as graduates, indicated that the unit was helpful to them in doing what they perceive as a difficult part of their job. This project suggests that developing support systems for students in their clinical experience and for professional dietitians to help manage the stress of working with seriously and terminally ill clients should be one of the goals of death education rather than trying to change attitudes toward death on either a pre-service or an in-service basis.

The effectiveness of a short curriculum unit in death education for dietetic students.

Dietetic educators are concerned with preparing their students to interact effectively with seriously/terminally ill patients in clinical settings. In this study, a short death education curriculum unit including multi-media teaching materials was designed, implemented, and evaluated. The subjects were 47 junior students enrolled in three coordinated programs. Instruments were adopted or adapted to assess the following items: knowledge of the grief process, personality traits of empathy and dogmatism, fear of death, fear of interacting with the dying, attitudes toward working with terminally ill clients as part of the professional role of dietitians, and clinical performance. Scores for the traits of empathy and dogmatism were negatively related, and students with a higher degree of religious conviction had lower death fear scores. Although no significant changes were found in any of the attitude scores after the curriculum unit, most students indicated that the unit made them feel more comfortable about working with the seriously ill. Students and faculty recommended that death education be included for dietetic students.