Hospital Dietitians Research Articles

Development of a team-specific research strategy using a modified Delphi method in a regional public hospital dietetics department.

Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers. The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building. Mixed method study. Dietetics department of a regional tertiary hospital (Modified Monash Category 2). All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration. Self-rated response to research capacity and culture to produce a dietetics-specific research strategy. Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy. The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

Clinical performance of the infant nutrition early warning score in routine practice across four international clinical settings in Europe: A study by the ESPGHAN special interest group in clinical malnutrition.

There is a scarcity of nutritional screening tools for use in infants (<1 year). The infant Nutrition Early Warning Score (iNEWS) has been developed to identify infants who need further dietetic review. We introduced the iNEWS into clinical practice and evaluated its performance in Scotland, Belgium, Athens and Bulgaria. Of the 352 infants screened, 72 (20%) were placed in the high iNEWS category, and of these, 70 (97%) were reviewed by a hospital dietitian. iNEWS produced a true positive rate of 80% which increased to 96% after accounting for anticipated misclassified cases due to prematurity. In Belgium, false positive screens had a shorter length of stay (p = 0.014). Otherwise, misclassification was not related to a specific iNEWS component. This study corroborates previous research, underscoring the validity of iNEWS as a dietetic referral tool and demonstrating that it can be integrated into "real-world" clinical practice across international settings with diverse healthcare resources.

Ascertainment of Nutrition Care Process (NCP) Implementation and Use of NCP Terminologies (NCPT) among Hospital Dietitians in the Philippines.

The Nutrition Care Process (NCP) is a systematic method used by dietitians to provide high-quality nutrition care resulting in good patient outcomes. This study aimed to assess the NCP implementation and use of NCP Terminologies (NCPT) among hospital dietitians in the Philippines. Specifically, the study aimed at assessing the knowledge, perception, and practices on NCP and use of NCPT and correlate them with the dietitians' education, and professional and employment profile; and explain the barriers and facilitators of the practice of NCP and use of NCPT among hospital dietitians in the Philippines. The knowledge, perception, and practices (KPP) on NCP and NCPT of the dietitians employed in the Philippine Department of Health's licensed level 3 hospitals were determined using a validated questionnaire. Significant factors associated with the KPP were also determined. The barriers and facilitators of the practice of NCP and NCPT were determined using focus group discussion and key informant interviews of chief clinical dietitians and hospital administrators, respectively. The study revealed that majority of the participants had a high level of knowledge on NCP and NCPT, positively perceived its implementation, and more than half of them implement NCP and NCPT in the hospitals. The participants' knowledge on NCP and NCPT was significantly associated with research involvement and active membership in a professional organization. While the practice of NCP and NCPT was significantly associated with having NCP-related trainings, frequency of trainings, and active membership in a professional organization. The barriers to NCP implementation were insufficient resources; lack of orientation, trainings, and support; organizational and administrative constraints; pandemic constraints; insufficient time; and lack of confidence to conduct NCP. While the facilitators of implementation were collaboration, dedication, and commitment of the healthcare team; institutionalization of NCP laws and policies; budget allocation for NCP-related activities; monitoring and consistency of NCP implementation; and work schedule. The findings suggest that the implementation of NCP and NCPT in the Philippines needs further support from the institution, professional organizations, and policy makers by developing strategies to cope with the barriers, and strengthen the facilitators and factors associated with practice.

Long-term follow-up in patients with coeliac disease in the pandemic-era: a view from Sheffield the NHS England national centre for adult coeliac disease.

To explore patients' follow-up preferences. Optimal follow-up strategies for patients with coeliac disease remain a subject of debate. Research suggests patients' prefer review by dietitians with a doctor available as required. Patients with coeliac disease under review at our centre, completed a questionnaire assessing their views on what makes follow-up useful based on specific criteria. Bloods tests, symptoms review, dietary assessment, opportunity to ask questions and reassurance. Patients' preferences between follow-up with a hospital doctor, a hospital dietitian, a hospital dietitian with a doctor available, a general practitioner, no follow-up or access when needed were also evaluated. 138 adult patients completed the questionnaire, 80% of patients reported following a strict gluten free diet (mean diagnosis was 7.2 years). Overall, 60% found their follow-up to be 'very useful' valuing their review of blood tests and symptoms (71%) reassurance (60%) and opportunity to ask questions (58%). Follow-up by a dietitian with a doctor available was the most preferred option of review (p<0.001) except when compared to hospital doctor (p=0.75). Novel modalities of follow-up such as telephone and video reviews were regarded as of equal value to face-to-face appointments (65% and 62% respectively). Digital applications were significantly less preferable (38%, p<0.001). Follow-up by a dietitian with a doctor available as needed was the most preferred follow-up method. However, in this study follow-up by a dietitian with doctor available and hospital doctor alone was statistically equivalent. Many patients consider telephone and video follow-up of equal value to face-to-face reviews.

Awareness of Dash Diet among Hypertensive Patients in Ido-Osi Local Government Hospitals, Ekiti State Nigeria

The study investigated the level of awareness of the DASH diet among hypertensive patients in Ido-Osi local government hospitals, Ekiti State Nigeria. The study adopted a descriptive survey design with three specific purposes, three research questions, and one null hypothesis to guide the study. The population of the study is 282 hypertensive patients, which include both in and outpatients from the seven local government hospitals who were present at the moment of data collection. No sampling technique was used as the whole of the population was used. A 27- item structured and validated questionnaire was used in the data collection and the data analysis was done using Mean and Standard deviation by SPSS version 20.0 and ANOVA for the analysis of the one null hypothesis. Cronbach Alpha Reliability Method was used to determine the internal consistency and 0.81 was obtained. The major findings of the study are the poor level of awareness of the DASH diet as revealed in their poor consumption of fruits and vegetables, consumption of red meat, sugars, sweets, saturated fats, and cholesterols among others. It also reveals that factors like illiteracy and economic factor among others challenge their awareness about the DASH diet. Strategies developed to increase awareness of the DASH diet among others include nutrition education and the installation of registered dietitians in government hospitals.

The role of the dietitian in the hospital team. The current situation in Poland in relation to the needs of society

Background: Nutrition that is adequate to the patient’s health status is a component of co-determining factors in improving the patient’s health. Moreover, appropriate activities of a dietician, such as assessing the nutritional status or educating patients, are counted among the determinants conditioning the effectiveness of the conducted treatment. The number of employed dietitians in hospitals is low, which results in 76-740 patients per one specialist, which in turn makes effective education impossible. The aim of this study was to compare the duties of dietitians working in Polish hospitals in relation to the needs of the society. Material and methods: The research tool consisted of two original, anonymous questionnaires, addressed to the Polish public and to active dietitians. The analysis of results was based on 595 questionnaire results, including 93 from nutritionists. Results: Of the respondents who were admitted to the hospital ward, 83.3% had no contact with a nutritionist (N=347). The surveyed dietitians most often declared that there were two dietitians working at the health care provider employing them, with the smallest number being 1 and the largest number being 55. Only one in three respondents received dietary recommendations upon discharge from the hospital (N=133; 32.1%). Nearly half of dietitians do not prepare menus (48.4%). According to the public, a dietitian should be involved in nutritional counseling, developing menus for the hospital kitchen or catering, and nutritional recommendations for patients discharged from the hospital. Conclusions: Dietitians with the right qualifications and specialties, integrated into the health care workforce, can have a huge impact on the proper dietary therapy of patients. As a result, there is a high probability of increasing the effectiveness of treatment, resulting in health service savings and support for the medical community.

Investigating the dietary knowledge, attitudes, and beliefs of Australian patients with cancer.

There is evidence linking diet to the risk of developing cancer and preventing recurrence, but the therapeutic value of food in treating cancer remains unclear. Therefore, guidelines for well-nourished patients with cancer are based on general healthy eating recommendations. This study aims to describe patients' knowledge, attitudes, and beliefs towards the role of diet and cancer. A cross-sectional survey was undertaken between July 2016 and January 2017. Patients being reviewed by Medical Oncology at a tertiary cancer service were invited to complete a questionnaire. One hundred and nine patients participated, with 61% receiving curative treatment. Median body mass index was 26.9 kg/m2 . A high frequency reported weight change (72%) and dietary modifications (reduction in overall intake; 62%). Patients were more likely to modify their diet if they had experienced weight change [odds ratio (OR): 3.59, 95% confidence interval (CI): 1.49-8.63], had malignancy-related anorexia (OR: 2.38, 95% CI: 1.06-5.32), strongly believed that diet contributed to their cancer (OR: 9.09, 95% CI: 2.55-32.44) or felt that nutrition played an important role in treatment (OR: 4.50, 95% CI: 1.95-10.40). Dietary information was largely sought from their hospital dietitian (51%), the Internet (39%), or treating oncologist (35%), of whom 47% and 57% found the information from their hospital dietitian and oncologist helpful, respectively. Our survey confirms patients place great importance on diet as part of their cancer management. Evidence-based dietetic services currently focus on managing malnutrition during treatment, but this study has identified hospital clinicians are not necessarily providing dietary information to meet patient expectations and thus a potential gap in patient-centred nutrition services for this patient population.

A Practical Approach to Identifying Pediatric Disease-Associated Undernutrition: A Position Statement from the ESPGHAN Special Interest Group on Clinical Malnutrition.

Disease-associated undernutrition (DAU) is still common in hospitalized children and is generally accepted to be associated with adverse effects on disease outcomes; hence making proper identification and assessment essential in the management of the sick child. There are however several barriers to routine screening, assessment, and treatment of sick children with poor nutritional status or DAU, including limited resources, lack of nutritional awareness, and lack of agreed nutrition policies. We recommend all pediatric facilities to 1) implement procedures for identification of children with (risk of) DAU, including nutritional screening, criteria for further assessment to establish diagnosis of DAU, and follow-up, 2) assess weight and height in all children asa minimum, and 3) have the opportunity for children at risk to be assessed by a hospital dietitian. An updated descriptive definition of pediatric DAU is proposed as "Undernutrition is a condition resulting from imbalanced nutrition or abnormal utilization of nutrients which causes clinically meaningful adverse effects on tissue function and/or body size/composition with subsequent impact on health outcomes." To facilitate comparison of undernutrition data, it is advised that in addition to commonly used criteria for undernutrition such as z score < -2 for weight-for-age, weight-for-length, or body mass index <-2, an unintentional decline of >1inthese z scores over time should be considered as an indicator requiring further assessment to establish DAU diagnosis. Since the etiology of DAU is multifactorial, clinical evaluation and anthropometry should ideally be complemented by measurements of body composition, assessment of nutritional intake, requirements, and losses, and considering disease specific factors.

The status of clinical nutrition in hospitals of Guilan province, Iran - A mixed-method study.

nutritional therapy has an important role in the development of medical care services, and quantitative and qualitative assessments of the status of clinical nutrition in hospitals is crucial. This study aimed to explore the current status of clinical nutrition in hospitals of Guilan province, Iran. this quantitative-qualitative (mixed method) study was performed on public hospitals in Guilan province, Iran (N = 26). The required information was collected by visiting the hospitals and interviewing with hospital dietitians. The data collection tool had two quantitative and qualitative subscales. The quantitative subscale included a 21-item checklist containing information about the referral system, cooperation of hospital staff in clinical nutrition, clinical nutrition staff status, enteral nutrition, and parenteral nutrition. in more than 40 % of hospitals the patients were not adequately referred to a dietitian. In 35 % of hospitals, cooperation of other departments in the field of clinical nutrition was insufficient. In 55 % of hospitals with intensive care unit (ICU), enteral nutrition was not provided properly. None of the hospital properly provided parenteral nutrition for their patients. The most important problems mentioned by hospital dietitians included noncompliance of the food sector employer with food programs, insufficient number of hospital dietitians, and nonpayment of consulting fees to dietitians. Coverage of diet services by health insurance was the most common suggestion of dietitians to promote diet therapy in hospitals. the situation of providing nutritional services to patients in public hospitals is not favorable in terms of quantity and quality in Guilan province, Iran. Designing the necessary policies to reorient the clinical nutrition system in hospitals and ultimately promote health and accelerate patient recovery is warranted.

The Status of Enteral Nutrition Formula Use by Dietitians in Hospitals Within Busan and Gyeongnam Area.

This study was conducted to analyze the status of medical food selection process in hospitals within Busan and Gyeongnam area. The survey was distributed to 396 hospitals (general, tertiary and long-term care hospitals) and finally 68 surveys were used for analysis. The questionnaire consisted of 9 general items and 10 items related to enteral nutrition (EN). From the survey we found out that general hospitals and tertiary hospitals normally hire clinical dietitian, while long-term care hospitals hire dietitians with no further qualifications (χ2 = 27.918, p < 0.001). A significant relationship was found between hospital size and the priority for choosing medical foods for patients (χ2 = 11.852, p < 0.05). In general and tertiary hospitals, medical foods were provided exactly according to the doctor's prescription, whereas in long-term care hospitals, only half followed the doctor’s direction and half of them provided the products that has been conventionally used. There was also a significant relationship between hospital size and the method for determination of nutrition requirements (χ2 = 20.496, p < 0.001). Finally, the priority of considerations when developing a ‘medical food guidelines’ was shown in the following order; 1) the type of medical food that can be selected according to the disease state, 2) the nutrient content and comparison table for commercial products, and 3) how to manage complications that may occur when supplying medical food for patients. Developing an EN practice guideline for making a sensible selection of medical foods will provide a valuable information for better patient care.

Assessment of the Dietitian Experts’ Role in Khartoum State Hospitals-Sudan

Background: Nutrition is a major lifestyle factor in health promotion, prevention and treatment of several population health issues [1]. There are some published studies that show the benefits associated with nutrition interventions provided by dietitians but there is still a need for studies that go beyond the intervention approach to explore these roles teams [2]. In this study out of a total of 227 dietitians in Khartoum state government hospitals, only 42 participated in the electronic questionnaire. The majority (31.0%) of these dietitians were aged between 40-49 years with 93.10% experienced between 6-10 years, Also, most of them (52.4%) have post-graduate studies and have a good awareness of their field of specialization. However, they pointed out that there are some obstacles to work, such as working components (31.1%).&#x0D; Objectives: The main ejective of this study was to assess the dietitian experts’ role in Khartoum hospital state, The specific objectives was to assess the dietitians role, services provided, dietitian knowledge in Khartoum hospitals state, to assess the level of performance of dietitian experts and their specializations, and whether there are any impediments to doing so.&#x0D; Study design (method used): The researcher(s) adopted a cross-sectional descriptive analytical study. An online electronic questionnaire was sent to a dietitians in government hospitals in Khartoum state in the period from September 18 to October 18, 2021, as a data collection tool to identify the participants’ socio-demographic characteristics, services provided, and Knowledge assessment After the approval of the head of the department at the Ministry of Health, the electronic questionnaire was sent to the dietitians in hospitals through Google, then the data was analyzed using the SPSS program and placed in the tables.&#x0D; Sampling: The questionnaire targeted all dietitians experts in government hospitals in Khartoum state (227) but the number that completed the questionnaire was 42.&#x0D; Problem Statement: There are not many studies that explain the role and importance of dietitian in hospitals and some performance problems, so I wanted to shed light on these aspects.&#x0D; Hypotheses: Due to my work for several years in Khartoum state hospitals, I expect that the nutritionist will have the scientific information that would enable them to perform, but they lack the possibility of having work tools to help that.&#x0D; Setting: The research was conducted in the state of Khartoum, which is the capital of Sudan and inhabited by about 8 million people, representing the various cultures and races in Sudan. The nutrition departments are affiliated to the Hospital Administration at the Ministry of Health, which has close to 54 of government hospitals, which providing service for 24 hours, including general and specialized hospitals [3,4].&#x0D; Participants: The number of dietitians in government hospitals was approximately 227, and only 42 of them participated in completing the questionnaire.

Entrustable Professional Activities for Undergraduate Nutrition Student Clinical Training: Development and Implementation

Abstract Objectives Entrustable professional activities (EPAs) have been applied to postgraduate and undergraduate medical training, but the application of nutrition intern students is rare. The clinical training of nutrition intern students must be connected with the nutrition care ability after graduation. Outpatient diabetes nutrition care is an important job of hospital dietitian. Therefore, this is the good point for the development of EPAs evaluation. The objective of this study was to describe the development of EPAs for nutrition intern training in the nutrition department of a medical center. Methods We chose the topic “Diet and health education for diabetic patients in outpatient clinics” and set the EPAs framework. EPAs was developed through an iterative consensus process involving the advanced dietitians. The content includes task description, capabilities (knowledge, skills, attitudes and behaviors), evaluation information, setting the trust level and validity period. The evaluation was established through expert validity. Final EPAs revisions followed from the multisource feedback. The Clinical Competency Committees (CCC) was established for final evaluation and approval. Results The EPAs was piloted for intern students in the Nutrition Department of the Medical Center from 2019. The assessment methods include test, mini-CEX, ad-hoc EPA, OSCE. The assessment content includes the knowledge of diabetes medical, diet, drug, clinical consultation, education, empathy and attitude, etc. Students were evaluated during each period of training. Finally, all the evaluation results were summarized and the CCC gave each student a credit rating. Conclusions Through multiple evaluations and timely feedback, the ability of intern students was defined in more precision. It allowed clinical teachers to achieve a teaching consensus. Combine competence with actual work, and integrate evaluation with authorization. We need to construct a complete information system to make evaluation more efficient in the future. Funding Sources None.

Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care

BackgroundMalnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.MethodsApplying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel.ResultsTwenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement.ConclusionsThis study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice.

Determinants of Research Capacity and Involvement of Hospital Dietitians in Selected Hospitals in Metro Manila

Objective. This study aimed to: 1) describe the current state of research activity/involvement and capacity among selected tertiary level government and private hospital dietitians; 2) identify factors associated with research capacity and involvement; and 3) develop policy recommendations to improve the current research activity/involvement towards evidence-based practice among hospital dietitians. Methods. This is a cross-sectional descriptive study. A total of randomly selected 181 hospital dietitians from selected hospitals in Metro Manila completed a pre-tested structured self-administered questionnaire, which elicited the socio-demographic characteristics, research activity/involvement, research capacity, perception, attitude and knowledge (PAK) of the respondents. Descriptive statistics were generated. Pearson Correlation was determined between socio-demographic characteristics and research activity/involvement score and research capacity score. Linear multiple regression analysis was conducted to test whether perceptions, attitudes and knowledge score are factors that predicted research activity/involvement and research capacity. Results. No significant difference was observed in hospital dietitians’ research capacity scores based on gender, age, educational attainment, hospital affiliation, and job description. Majority (97%) of the hospital dietitians had very little participation (10%) or involvement in any type of research activity/involvement. The significant factors that were predictive of research activity/involvement scores and research capacity scores were percent of time for research and hours per week devoted to research, respectively. Percent of time for research was significantly predictive of research knowledge of respondents. Conclusion. The findings in this present study showed the research activity/involvement and capacity of hospital dietitians in Metro Manila were dismally low. The significant factors that were predictive of research activity/involvement scores and research capacity scores were percent of time for research and hours per week devoted to research, respectively. To support the development of research capacity and involvement of hospital dietitians, policy-makers and healthcare organizations can optimize capability-building strategies at the academic level, hospital dietitian level, and institutional level.

Improved meals service and reduced food waste and costs in medical institutions resulting from employment of a food service dietitian \u2013 a case study

BackgroundA recurring problem in medical institutions is patients not always receiving food meeting their nutritional and medical needs. A proposed contributing factor is non- inclusion of dietitians in food service staff. Recently, positions for food service dietitians in hospitals were created. For the newly defined role of “Food Service Dietitian”, comprehensive training courses were developed (70 dietitians participated).ObjectiveTo examine the impact of the addition of the role of a “Food Service Dietitian” in medical institutions on suitability of foods served, food costs and food waste.MethodsA three years (2014–2017) national case study to examine the new role’s impact was carried out, in 18 hospitals, nine of which employ a food service dietitian (intervention), and 9 without (control). The number of nutritional analyses of menus was checked, as was the extent of kitchen staff training, and how often night meals were served for all patients. Data were gathered regarding food costs and waste with respect to food distributed to staff and patients. Food costs savings and waste reduction were calculated, based on reduction in provision of unnecessary meals, at a cost of 18 NIS per day per meal.ResultsKitchen staff training was carried out in all intervention institutions, and not in the controls. In most controls, nutritional analyses were not performed, whereas in the intervention hospitals, full analyses were performed and tailoring of menus to specific department requirements improved significantly. In most intervention hospitals, late night snacks were provided, this not being so in the controls. Total food cost savings of $229,569 per annum was seen in the six intervention hospitals, attributable to 4 factors:Meals not delivered to fasting patients, or those receiving parenteral/enteral nutrition- cost savings of 328,500 NIS ($93,857)Better tailoring and monitoring of food delivered to the wards and staff (bread, cheese, milk etc)- annual cost savings of 235,000 NIS ($67,142) in the hospitals with a food service dietitian.Checking expiry dates of medical foods, and improved communication between the wards, the kitchen and the food distribution centers, has lessened food waste with savings of 5% from the medical food budget per annum of 40,000 NIS ($11,428).As a result of dietitian-performed nutritional analyses, tailoring of food provided according to the patient’s medical and nutrition needs was improved. In one hospital, after re-evaluation of serve sizes in high protein diets, sizes were reduced while retaining adequacy, with immediate cost savings of 200,000 NIS ($57,142) per annum.ConclusionsImplementation of the new role of Food Service Dietitian led to cost savings and significant improvements in adherence to the nutritional care plan.

Evaluation of the efficacy of simplified nutritional instructions from physicians on dietary salt restriction for patients with type 2 diabetes mellitus consuming excessive salt: protocol for a randomized controlled trial

BackgroundHypertension is present in more than 50% of patients with type 2 diabetes mellitus. Dietary salt restriction is recommended for the management of high blood pressure. Instructions on dietary salt restriction, provided by a dietitian, have been shown to help patients reduce their salt intake. However, appointments for the dietitians in hospitals are often already fully booked, making it difficult for patients to receive instructions on the same day as the outpatient clinic visit.AimThe aim of this trial is to test a new intervention to assess whether guidance on dietary salt restriction provided by physicians during outpatient visits is effective in reducing salt intake in patients with type 2 diabetes mellitus who have an excessive salt intake.MethodsIn this unblinded randomized controlled trial (RCT), a total of 200 patients, male or female, aged between 20 and 90 years, who have type 2 diabetes mellitus and consume excessive salt will be randomly assigned to two groups: an intervention group and a control group. In addition to being given routine treatment, participants in the intervention group will be given individual guidance on restricting their dietary salt intake by a physician upon enrollment. The control group will only be given routine treatment. Participants will be followed up for 24 weeks. The primary outcome will be dietary salt intake, which will be assessed at baseline and at 8, 16, and 24 weeks. The secondary outcomes, including body weight, body mass index, hemoglobin A1c level, blood pressure, blood glucose level, serum lipid profile, and urinary albumin excretion level, will be assessed at baseline and at 8, 16, and 24 weeks.DiscussionThe results of this RCT have the potential to provide a simple and novel clinical approach to reduce salt intake among patients with type 2 diabetes, making regular visits to their physician, in outpatient facilities. This protocol will contribute to the literature because it describes a practical intervention that has not been tested previously, and it may serve as guidance to other researchers interested in testing similar interventions.Trial registrationUniversity Hospital Medical Information Network (UMIN), UMIN000028809. Registered retrospectively on 24 August 2017. http://www.umin.ac.jp.

Factors Affecting Job Satisfaction of Hospital Dietitians

Factors Affecting Job Satisfaction of Hospital Dietitians

Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients

Obesity, defined as a BMI≥30kg/m2, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N=3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-hfood intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n=750; 75% females; 61±15 years; 37±7kg/m2). Fourteen percent (n=105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N=30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients. Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients.

病院栄養士の立場から(シンポジウム:糖尿病の一次,二次予防のための患者,住民教育)

病院栄養士の立場から(シンポジウム:糖尿病の一次,二次予防のための患者,住民教育)

A clinical nutritional information system with personalized nutrition assessment

Background and objectiveTraditional nutrition evaluations not only require the use of numerous tables and lists to provide sufficient recommendations for patients’ diets but are also very time-consuming due to cross-referencing and calculations. MethodsTo personalize patient assessments, this study implemented a Clinical Nutritional Information System (CNIS) to help hospital dietitians perform their daily work more effectively in terms of time management and paper work. The CNIS mainly targets in-patients who require cancer-nutrition counselling. The development of the CNIS occurred in three phases. Phase 1 included system design and implementation based on the Nutrition Care Process and Model (NCPM) and the Patient Nutrition Care Process. Phase 2 involved a survey to characterize the efficiency, quality and accuracy of the CNIS. In Phase 3, a second survey was conducted to determine how well dietitians had adapted to the system and the extent of improvement in efficiency after the CNIS had been available online for three years. ResultsThe work time requirements decreased by approximately 58% with the assistance of the CNIS. Of the dietitians who used the CNIS, 95% reported satisfaction, with 91.66% indicating that the CNIS was really helpful in their work. However, some shortcomings were also evident according to the results. ConclusionsDietitians favoured the standardization of nutritional intervention and monitoring. The CNIS meets the needs of dietitians by increasing the quality of nutritional interventions by providing accurate calculations and cross-referencing for information regarding patients’ conditions, with the benefit of decreasing the processing time, such as handwritten documentation. In addition, the CNIS also helps dietitians statistically analyse each patient's personal nutritional needs to achieve nutritional improvement.