Clinical Nutrition Management Research Articles

Clinical effect of enteral nutrition with eicosapentaenoic, docosahexaenoic, and gamma-linolenic acids for preventing bedsores after neurosurgery

Rationale: Enteral diets enriched with EPA・DHA・GLA contributed to preventing bedsores in patients after neurosurgery. The beneficial effect of the EPA・DHA・GLA diets was associated with a lower occurrence of new bedsores in the clinical nutrition management of neurosurgical outcomes.

Clinical Course and Nutritional Management of Propionic and Methylmalonic Acidemias.

Propionic and methylmalonic acidemias result in multiple health problems including increased risk for neurological and intellectual disabilities. Knowledge regarding factors that correlate to poor prognosis and long-term outcomes is still limited. In this study, we aim to provide insight concerning clinical course and long-term complications by identifying possible correlating factors to complications. Results. This is a retrospective review of 20 Egyptian patients diagnosed with PA (n = 10) and MMA (n = 10) in the years 2014–2018. PA patients had lower DQ/IQ and were more liable to hypotonia and developmental delay. The DQ/IQ had a strong negative correlation with length of hospital stay, frequency of PICU admissions, time delay until diagnosis, and the mode ammonia level. However, DQ/IQ did not correlate with age of onset of symptoms or the peak ammonia level at presentation. Both the growth percentiles and albumin levels had a positive correlation with natural protein intake and did not correlate with the total protein intake. Additionally, patients on higher amounts of medical formula did not necessarily show an improvement in the frequency of decompensation episodes. Conclusion. Our findings indicate that implementation of NBS, vigilant and proactive management of decompensation episodes, and pursuing normal ammonia levels during monitoring can help patients achieve a better neurological prognosis. Furthermore, patients can have a better outcome on mainly natural protein; medical formula should only be used in cases where patients do not meet 100–120% of their DRI from natural protein.

Under-reporting of the energy intake in patients with type 2 diabetes.

In patients with type 2 diabetes mellitus (DM), an accurate assessment of food intake is essential for clinical nutritional management. Tools such as the food frequency questionnaire (FFQ) and 24-h food record (24HR) identify dietary habits in support of dietary planning. However, it is possible that these tools have reporting errors with respect to assessing food intake, particularly energy intake (EI). A cross-sectional study was conducted in patients with type 2 DM. EI was assessed by the FFQ and 24HR tools. Resting energy expenditure (REE) was measured by indirect calorimetry. Data were analysed using a kappa test, t-test and Spearman's correlation coefficients. Under-reporting was assessed using the EI/REE ratio. Patients with values <1.18 and <1.10 for FFQ and 24HR, respectively, were considered as under-reporting. We evaluated 55 patients [mean (SD) 62.7(5.3)years old, duration of diabetes 11.2(7.3)years, 52.7% female]. The mean (SD) EI assessed by FFQ was 1797.7(641.3) and as assessed by 24HR was 1624(484.8)kcalday-1 . The mean (SD) REE was 1641.3(322.3)kcalday-1 . The mean (SD) ratios FFQ/REE and 24HR/REE were 1.11(0.38) and 1.01(0.30), respectively. The tools showed a moderate agreement for under-reporting of EI (kappa=0.404; P=0.003). Moderate and positive correlations between REE were observed with FFQ (r=0.321; P=0.017) and 24HR (r=0.364; P=0.006). According to the tools, the under-reporting was observed in approximately 65% of patients. The majority of patients with type 2 DM under-reported their calorie intake, as assessed by FFQ and 24HR. REE showed a positive correlation with both tools.

A Study on The Performance and Importance of Clinical Nutrition Management Using IPA Analysis

A Study on The Performance and Importance of Clinical Nutrition Management Using IPA Analysis

Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics.

In 2014, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommended indicators to identify malnutrition in children aged 1 month to 18 years. The purpose of this study was to evaluate current practices and the effectiveness of the consensus statement-recommended pediatric malnutrition indicators. A cross-sectional electronic survey link was posted in the Pediatric Nutrition Practice Group (subscribers = 3160) and Clinical Nutrition Management Practice Group's Pediatric Subunit (subscribers = 177) community discussion boards. Additionally, flyers with the survey link were distributed to registered dietitian nutritionists (RDNs) currently working in pediatrics at the 2018 Food & Nutrition Conference & Expo. Frequencies described participant characteristics, awareness of indicators, and use of indicators. Researchers used the Fisher exact test to determine associations between categorical variables. Two hundred eighty-one surveys were included in data analysis. A majority of RDNs (88.6%) reported they knew the indicators existed and considered themselves knowledgeable about the indicators. Weight loss was the most frequently used indicator, with 224 RDNs (80%) reporting use as often or always. Mid-upper arm circumference (MUAC) was the least used indicator with only 68 RDNs (25%) using it often or always. Most RDNs (71.5%) reported that their facility used International Classification of Disease, Tenth Revision codes to document malnutrition. RDNs working with pediatric populations consistently use the recommended malnutrition indicators; however, further education is needed on the appropriate use of MUAC and length/height per age as malnutrition indicators.

A Current Gap Analysis of Education for Clinical Nutrition Managers

Clinical nutrition managers (CNMs) administer clinical nutrition and other services. An online survey was distributed to CNMs to examine the importance of education for specific CNM job tasks, the extent to which educational needs are met, and what opportunities exist to enhance the knowledge and skills of CNM practitioners. Gap analyses were employed to interpret variances in the educational variables. Results indicate that CNMs perceive education as important for all job tasks and that educational needs are not being met for all job tasks. The greatest opportunities for education were with ensuring compliance with regulations and accreditation standards and managing human and financial resources.

Analysis of Clinical Nutrition Management Performance and Importance of Clinical Nutritionists According to the Accreditation of Mental Medical Institutions

Analysis of Clinical Nutrition Management Performance and Importance of Clinical Nutritionists According to the Accreditation of Mental Medical Institutions

Application of STRONGkids to screen infants with lower respiratory tract infection and its possible influence on clinical outcome

Objective To investigate the incidence of nutritional risk in infants with lower respiratory tract infection, and to compare the effects of different nutritional risks on clinical outcomes, and to provide evidence for clinical nutritional management of infantile lower respiratory tract infection. Methods Infants and young children with lower respiratory tract infection who were hospitalized in our hospital from January 2013 to March 2016 were selected as subjects. Nutritional risk screening was performed using the Nutritional Status and Growth Risk Screening Tool (STRONGkids). Results A total of 957 infants with lower respiratory tract infections were included in the study. The incidence of high nutrition risk and low and medium nutritional risk were 17.6% and 82.4%, respectively. The clinical cure rate was 68.5% and 71.4% respectively. The children with pneumonia and bronchitis had high nutritional risk. The incidence rates were 20.60% and 4.87%, respectively, and the difference was statistically significant (χ2=25.52, P=0.000). Time-effect single factor analysis (Kaplan-Meier method): The hospitalization time for infants with low nutritional risk and high nutritional risk was 9.3(0.3) d and 13.3(1.0) d, respectively. The difference between the two groups was statistically significant. (χ2=28.33, P=0.000), the total hospitalization expenses were 5 653.5(224.8) yuan and 10 079.5(1 755.8) yuan respectively. The difference between the two groups was statistically significant (χ2=4.47, P=0.034). Multivariate COX regression analysis: High nutritional risk was a risk factor for hospitalization of hospitalized infants with lower respiratory tract infection (RR=1.57, P=0.024). Conclusion There is a high incidence of high nutritional risk in infants with lower respiratory tract infection. Compared with children with low and moderate nutritional risk, the hospitalization time is longer, the hospitalization cost is increased, and the clinical cure rate is lower, which is the risk of clinical outcome. factor. Therefore, it is necessary to conduct nutrition risk screening for infants with lower respiratory tract infections, and provide a theoretical basis for clinical nutrition evaluation and nutritional intervention. Key words: Respiratory infections; Infants; Nutritional status and growth risk screening tools

Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management

Clinical nutrition management (CNM) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for clinical nutrition services within an organization. Although RDNs in CNM are typically employed in acute care, they are also employed in settings where management of nutrition services is required, such as foodservice departments, ambulatory clinics, telehealth services, public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty departments, for example, dialysis units or cancer centers. RDNs in CNM aim to create work environments that support high-quality customer-centered care, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The CNM Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in CNM for three levels of practice: competent, proficient, and expert. The SOPP describes six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in CNM are written with the leader in mind—to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

Clinical ladders are positively associated with job satisfaction and career advancement for registered dietitians in clinical nutrition management

Background: Following a change in reporting structure, Registered Dietitian Nutritionists (RDNs) in a Virginia hospital system provided patients with better care, cost savings, and almost doubled clinical nutrition staff from 2008 to 2013. Objective The study was conducted to determine if the administrative alignment of RDNs in their place of employment 1) allows them to perform to their greatest scope of practice and 2) influences job perceptions.Methods: A survey was developed and distributed nationally to CNMs and their coworkers. Statistical analyses: Using SPSS 24, univariate descriptive statistics and bivariate analyses were conducted. Contingency tables were generated and Pearson Chi-square tests and as appropriate Fishers’ exact tests were used to draw statistical inferences.Results: Respondents (n=508) represented four regions of the US with various job titles. Some reported to vice presidents of support services (34%) and others reported to vice presidents overseeing both clinical and support services (26%). Respondents, regardless of alignment, were either ‘satisfied’ (47%) or ‘very satisfied’ (36%) with their current positions. Most (74%) were in a nutrition department separate from food service. There was no difference in education (p=0.87) or pay (p=0.62) dependent on reporting structure. However, when RDNs reported to a clinical nutrition department, separate from food service, it was more likely that there was a clinical ladder for RDNs and there were more levels on the clinical ladder.Conclusion: This survey suggests alignment of a clinical nutrition department is associated with a higher likelihood that RDNs will have a clinical ladder to promote career advancement.

2017 regional survey on clinical nutrition management in acute care settings, Italy

2017 regional survey on clinical nutrition management in acute care settings, Italy

2017 regional survey on clinical nutrition management in acute care settings, Italy

2017 regional survey on clinical nutrition management in acute care settings, Italy

Relationship between nutritional status and the clinical outcomes of critically ill children

Objective To investigate the nutritional status and the clinical outcome of the critically ill children, and to provide scientific evidence for further clinical nutrition management. Methods Nutritional risk screening was performed on 1 183 critically ill children hospitalized at the Intensive Care Unit (ICU), Children′s Hospital of Nanjing Medical University from October 2016 to October 2017 by using the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the ICU including of Pediatric Intensive Care Unit (PICU), Surgical Intensive Care Unit (SICU) and Coronary Care Unit (CCU). Median age of the children was (2.6±2.4) years (29 d-12.9 years). Nutritional status was estimated, and scores of anthropometric parameters such as weight-for-age Z-score (WAZ) (<5 years) or body mass index-for-age Z-score (BAZ) (≥5 years)were calculated.The data on incidence of infectious complications, duration of ICU stay and mechanical ventilation, the total hospital expenses and in-hospital mortality were recorded. Results Of the 1 183 cases, 134 children(11.3%) had low nutritional risk, 746 children(63.1%) had moderate nutritional risk and 303 children(25.6%) high nutritional risk.The prevalence of severe malnutrition, moderate malnutrition and mild malnutrition was 8.1% (96/1 183 cases), 8.2% (97/1 183 cases), and 12.8% (151/1 183 cases) respectively.The severe malnutrition group had a higher incidence of high nutritional risk than other groups [74.0%(71/96 cases) vs.67.0%(65/97 cases), 40.4%(61/151 cases), 12.6%(106/839 cases)], and the differe-nce was statistically significant (P<0.001). The incidence of high nutritional risk in the CCU was higher than that than that in the PICU and SICU, and the difference was statistically significant [36.5%(96/263 cases), 23.8%(125/524 cases) and 20.7%(82/396 cases) respectively, P<0.01]. And the incidence of high nutritional risk was higher in infants[37.6%(198/527 cases)] than those in the other age groups[18.4%(52/282 cases), 12.0%(21/175 cases), 16.0%(32/199 cases)], and the difference was statistically significant (χ2=68.90, P<0.000 1). Children with a high nutritional risk had increased incidence of infectious complications [8.6%(26/303 cases) vs.4.7%(35/746 cases), 3.7%(5/134 cases)], incidence of mechanical ventilation[66.0%(200/303 cases) vs.41.4%(309/746 cases), 38.8%(52/134 cases)] and total hospital expenses (￥52 500 vs.￥39 700 and ￥48 700 RMB) compared with those with the moderate or the low nutritional risk, and the differences were statistically significant(all P<0.05). There were 16 deaths and 8 deaths (2.7%) in the high nutrition risk group, which was significantly higher than those in the moderate nutrition risk group [8 cases (1.1%)] and the low nutrition risk group[0 case(0)] (χ2=7.60, P=0.02). Conclusions Moderate or high nutritional risk is seen in the critically ill children, especially in infants and the children with congenital heart disease.Nutritional risk score is correlated with clinical outcomes.Nutritional risk screening and standard nutritional support are recommended so as to improve clinical treatment outcomes. Key words: Nutritional risk screening; Critically ill; Clinical outcome; Child

The Clinical Presentation and Nutritional Management of an Infant With Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a term used to describe postnatal withdrawal syndrome that occurs in infants as a result of fetal exposure to drugs. Signs of NAS include high-pitched cries, jitteriness, feeding difficulties, and low birth weight. If NAS is suspected, infant urine and/or meconium samples are sent for analysis. Management of NAS includes pharmacological treatment and nonpharmacological approaches. This case report highlights the management of an infant who presented with signs of NAS, had feeding difficulties and poor weight gain, was hospitalized for 6 months, and experienced delayed drug withdrawal.

Organization and management of clinical nutrition in Spain. How do we assess the quality of our activities?

Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.

Describing the Roles and Responsibilities of Nutrition Staff and Nutrition Care Policies in Acute Care Facilities

Using the results from a survey of 101 acute care facilities, this article describes the roles of nutrition professionals and nutrition care policies. The most common roles for clinical nutrition managers were policy development and monitoring for quality care (&gt;98%); nutrition and dietetic technicians, registered were most commonly involved in patient education (93%). Responsibility for nutrition screening varies, with nurses and registered dietitian nutritionists most frequently involved. The plurality of facilities (48%) requires a nutrition assessment within 2 days of positive screening. These data illuminate standard nutrition practices in acute care facilities and can be used for comparisons between facilities and over time.

Analysis on the results of clinical nutrition management survey in PICU critically ill children

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. Key words: Critically ill children; Nutrition management survey; Early enteral nutrition,

Progress in nutrition screening and management models of hospitalized patients

This review outlined the status of malnutrition in hospitalized patients around the world, introduced the application of various nutritional screening tools and elaborated the important effects of nutrition risk evaluation and intervention on clinical outcome of patients. To solve the problem of shortage of systematic and cooperative work in clinical nutrition management in China, software of nutrition screening and management was designed so as to simplify the nutrition management process and provide a powerful guarantee for promoting clinical nutrition treatment work. Key words: Review; Hospitalized patient; Nutrition assessment; Nutritional risk screening; Multidisciplinary team

Evidences of Kampo medicines for clinical nutrition management

Evidences of Kampo medicines for clinical nutrition management

Evaluating Clinical Nutrition Managers’ Involvement in Key Management Functions

Registered dietitian nutritionists are employed in the health care environment with various titles, including clinical dietitians, clinical dietitian-specialists, outpatient dietitians, pediatric dietitians, and directors of food and nutrition services. 1 Academy of Nutrition and Dietetics. Academy of Nutrition and Dietetics compensation and benefits survey of the dietetic profession 2015. http://www.eatright.org/salarysurvey. Published 2016. Accessed February 4, 2016. Google Scholar A less common role is that of clinical nutrition manager (CNM), who administers health care clinical nutrition services. 2 Clark K.M. Moore C. Trombley L. et al. Academy of Nutrition and Dietetics: Standards of professional performance for Registered Dietitians (competent, proficient, expert) in clinical nutrition management. J Acad Nutr Diet. 2012; 112: 1662-1669 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The full scope of the CNM’s role is ambiguous, including his or her daily tasks and their role preparation. This article provides a comparative benchmark between previous research 3 Witte S.S. Messersmith A.M. Clinical nutrition management position: Responsibilities and skill development strategies. J Am Diet Assoc. 1995; 95: 1113-1120 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar and current CNM practice. Previous research validated 46 job tasks of CNMs. 3 Witte S.S. Messersmith A.M. Clinical nutrition management position: Responsibilities and skill development strategies. J Am Diet Assoc. 1995; 95: 1113-1120 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Recent changes in health care have impacted managers’ roles and responsibilities and, thus, the need to assess whether previous CNM research is still applicable. Determining current CNM responsibilities is important so that the role and profession can keep pace with the dynamic needs of the health care sector. One also must align those CNM responsibilities with educational and development opportunities with that area of practice.