Physicians' perceptions of the role of clinical dietitians are changing.

We surveyed a selected group of physicians to determine their opinions regarding appropriate activities and educational background for hospital dietitians. Questionnaires were mailed to 401 physicians listed in the yellow pages of the 1988 San Jose/Santa Clara, Calif, telephone directory. Physicians were chosen from nutrition-related specialties such as cardiology, endocrinology, and gastroenterology. Questionnaires were returned by 123 (30%) physicians. Most physicians viewed dietitians as contributing members of the health care team. However, they believed that the physician should be responsible for ordering therapeutic diets. Most physicians (98%) agreed that one of the most important duties of the dietitian is to assure patient satisfaction with food served. Physicians (94%) also believed that presenting current nutrition information to hospital personnel is an important activity. Counseling patients was an area most physicians (99%) thought should be included in the educational background of dietitians. Sixty percent of the physicians indicated that it is important for the dietitian to understand blood and urine laboratory values. These results indicate that the perceived status of hospital dietitians by physicians has improved since earlier studies.

Nutrition-related backgrounds and counseling practices of doctors of chiropractic.

A questionnaire was designed and mailed to the entire membership (no. = 438) of the San Francisco Bay Area Chiropractic Society to determine their nutrition education backgrounds and counseling practices and the relationship of backgrounds and counseling practices and the relationship of backgrounds and information resources to counseling practices. Results, based on the 23% response rate, indicated that the hours of formal nutrition education in chiropractic college varied widely in the five categories of responses from zero to more than 120, with the median respondent falling in the median category (81 to 100 hours). Sixty percent of the respondents indicated that they provided nutrition information to their patients on a routine basis, and 38% provided information on request only. The major forms of nutrition information dissemination were counseling (87%) and written materials (74%). The majority of respondents reported that they diagnose osteoporosis, arthritis, and allergies and use nutrition treatments for those disorders as a part of overall therapy. Chiropractic journals and texts were the most frequently used sources of nutrition information. Awareness of the educational backgrounds of registered dietitians correlated positively with the use of dietitians as a resource for nutrition information (p less than .005). The survey results suggest a need for dietitians to become involved in the nutrition-related practices of chiropractors as sources for information and referral.

Southeast Asian renal exchange list.

More than 340,000 Southeast Asians (SE Asians) have immigrated to the United States since 1971. By 1984, 76,000 SE Asians had settled in California. In areas of the U.S. with large SE Asian populations, many foods specific to those people are readily available. Approximately 5% of the total U.S. population has medical problems that lead to kidney disease. Many SE Asian refugees have prior medical problems, such as hepatitis B, that may make them at significantly higher risk for kidney disease. A modified renal exchange list (excluding milk, carbohydrate supplement, and fat group) was developed. This list, made up of foods readily available and commonly eaten by the largest group of SE Asian immigrants, the Vietnamese, categorizes foods by protein, potassium, and caloric content. A separate list, indicating the phosphorus content of these foods, is also included. Asian grocery stores were visited to identify foods available for purchase by SE Asians. The foods were identified, and nutrient composition was found in food composition tables. Because the Vietnamese diet is high in potassium and sodium, planning renal diets poses problems for both patients and dietitians. Close monitoring of diet can retard the progression of renal disease. An exchange list such as this assists both dietitians and renal patients in this important task.