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PubMed2001

Developing a nutrition education package for Malaysian hemodialysis patients.

OBJECTIVE: To develop an education package with uniform nutrition messages appropriate for Malaysian patients undergoing hemodialysis. METHODS: Nutritional problems and socioeconomic, ethnic, cultural, and religious factors influencing food habits of HD patients were considered in planning the package. The package comprised a Flipchart and 55 food Fotocards. The Flipchart used a modular format to target nutrition education in stages. The food Fotocards were designed to help the patient plan a daily menu and enjoy greater food variety. Photographs related to common food servings carried symbols for significant nutrient sources of energy, protein, fat, sodium, potassium, and phosphate. A traffic-light color system quantified potassium and phosphate content. The package was evaluated by 25 respondents, composed of nephrologists, nurses, dietitians, and patients. RESULTS: Eighty percent of evaluators rated the Flipchart as good and 20% rated it as excellent, whereas 28% rated the Food Fotocards as good and 72% rated them as as excellent. CONCLUSION: This package is a useful nutrition education tool for both health educators and dietitians to present first-line nutrition advice to patients undergoing hemodialysis.

Diet↗
PubMed1979

A low-cholesterol menu in a steak restaurant.

A twelve-month pilot project was conducted to test public reaction to a special restaurant menu identifying food choices low in cholesterol and saturated fat. The Houston steak house in which the "Help Your Heart" menu was tested prepared foods according to guidelines from dietitians of the Diet Modification Clinic, Baylor College of Medicine. Two newspaper articles, a brief magazine feature, and regularly scheduled radio advertising spots publicized the special menu. At the end of each month of the test period, the number of orders from the special menu was tallied for fourteen randomly selected days. Monthly sales from the special menu ranged from 2.5 to 5.1 per cent, with an overall average of 3.4 per cent. There was no statistically significant change from the mean of the percentage of total sales from the special menu over the months. Despite the relatively low percentage of total sales, restaurant executives were pleased with the results of the study and planned to offer the low-cholesterol menu indefinitely, eventually in an expanded form.

Behavior Therapy↗
PubMed2003

Demand for a Medicare prescription drug benefit: exploring consumer preferences under a managed competition framework.

Several proposals for adding a prescription drug benefit to the Medicare program rely on consumer choice and market forces to promote efficiency. However, little information exists regarding: 1) the extent of price sensitivity for such plans among Medicare beneficiaries, or 2) the extent to which drug-only insurance plans using various cost-control mechanisms might experience adverse selection. Using data from a survey of elderly Wisconsin residents regarding their likely choices from a menu of hypothetical drug plans, we show that respondents are likely to be price sensitive with respect to both premiums and out-of-pocket costs but that selection problems may arise in these markets. Outside intervention may be necessary to ensure the feasibility of a market-based approach to a Medicare drug benefit.

Aged↗
PubMed1996

Moderating binge drinking: it is possible to change behaviour if you plan it in advance.

Recent theories of enactment suggest that behaviour change is increased by planning how, where, and when to execute a behavioural response. Drawing on these theories, a brief planning intervention was designed and its effectiveness compared to an information-based health promotion programme (control). All participants were given information about the safe limits per drinking occasion and the adverse consequences of binge drinking, and were asked to drink within the safe limits in order to avoid these consequences. In addition, participants in the planning group received an option menu of possible responses for refusing a drink, asked to choose one strategy and specify a time and place in which the chosen strategy would be implemented. The planning intervention group did not differ from the control group on reported likelihood of future binge drinking, nor on levels of past drinking, age and gender. At a 2-week follow-up, members of the planning intervention group reported lower drinking frequency than controls. The implications of prior planning for interventions aimed at reducing alcohol-related harm are discussed.

Adolescent↗
PubMed1993

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

Computer Systems↗
PubMed1983

Planning high-carbohydrate, high-fiber diets with a microcomputer.

Current research suggests that a diet high in carbohydrate and fiber (HCF) may be useful in the management of diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia. To meet the needs of our clinic population, a microcomputer program has been developed that allows for individualization of HCF menu patterns that satisfy both the diet prescription and the patient's preferences. Educational materials were prepared to guide and augment the HCF diet instruction. It is hoped that this comprehensive approach to diet planning and teaching can be applied in similar settings to facilitate the delivery of quality patient care.

Boston↗
PubMed2004

Taking the next steps in goal ascertainment: a prospective study of patient, team, and family perspectives using a comprehensive standardized menu in a geriatric assessment and treatment unit.

OBJECTIVES: To examine the performance of an expanded menu of goals in a geriatric rehabilitation setting incorporating patient, family, and team perspectives. DESIGN: Prospective comparative study. SETTING: Inpatient geriatric rehabilitation unit. PARTICIPANTS: Nineteen consecutive eligible inpatients and their family members and seven unit team members. MEASUREMENTS: Each participant independently reviewed a standardized menu of medical, functional, psychosocial, spiritual, and future planning goals, which were compared with the goals set by the healthcare team. RESULTS: On average, patients and their family members agreed on goals about half the time; family members tended to have more goals than patients. Agreement between the team and patients and families was poor (kappas=-0.11-0.33). The team was less likely to identify functional, psychosocial, spiritual, and future planning goals. CONCLUSION: Patients and families have a broad range of goals that are not always identified by the healthcare team. A comprehensive standardized menu is feasible and may be helpful in setting goals in a geriatric rehabilitation setting.

Aged↗
PubMed2003

[Navigation-supported surgery in the head and neck region].

Few of the pioneering manufacturers who attempted to develop navigation systems have been able to establish themselves within the market long-term. The same applies to the technological basis of these systems which aid intraoperative anatomical orientation. The first few systems registered the mechanical displacement of the navigational instrument's axes. Optoelectronic and electromagnetic methods are now prevalent. In contrast to electromagnetic systems, the "line of sight" between the camera system, the reference markers placed on the patient's head and the navigation instruments must remain unobstructed during the navigation process when using electrooptical navigation systems. Whereas, in the past, only preoperative CT scans were used for navigation, the integration of MRI and sonography--whose images can now be fused with each other and with those provided by other intraoperative imaging techniques such as fluoroscopy and endosonography--has become increasingly popular. Navigation systems require input of information about spatial conditions. This is carried out via procedures of registration and referencing, by means of which the relative position of reference markers at the head of the patient is correlated with the image data. The equipment is calibrated in the same way. Headsets, headbands and bone-anchored adapters are available for the fixation of the markers in the patient's head. Whereas the use of a headband or headset requires considerably less time, bone-anchored referencing increases the precision of the navigation system. The surgeon must be able to manage the different methods. In order to reduce the time required for preoperative preparation and to enhance the handling of the navigation processor for the surgeon, it is essential to have a clear menu. The surgeon is able to plan the steps involved in the surgery using the processor, define the access to the surgical site and control the surgery intraoperatively. Preoperative segmentation of functionally and clinically relevant structures enables minimally invasive surgery to be carried out, such as procedures with the aim of acquiring biopsy tissue and the search for foreign bodies. Following the technical development of the systems, the manufacturers are endeavouring to simplify their handling in close coordination with the users. The next step has to be the clinical evaluation of the navigation systems in accordance with the EBM standard, in order to establish this assistive method as routine clinical practice while applying meaningful medical criteria.

Endosonography↗
PubMed2006

Key facilitators and best practices of hotel-style room service in hospitals.

This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

Adolescent↗
PubMed1978

Automated purchasing: Forecasts to determine stock levels and print orders.

An automated purchasing system to optimize inventory levels of frozen foods, including meat items, while minimizing stock outages, was developed and implemented. Menu item forecast data were coordinated with on-hand quantities to automate the calculation of order quantities and printing purchase requisitions. The model selected also incorporated: (a) Safety stock level, (b) accumulated forecasts, and (c) accumulated orders already placed. The project was smoothly integrated into an on-going computer-assisted management system. All programs functioned as planned; computer documents were complete and accurate. The system design was retained for use in the foodservice operation.

Computers↗
PubMed2002

Bioregenerative food system cost based on optimized menus for advanced life support.

Optimized menus for a bioregenerative life support system have been developed based on measures of crop productivity, food item acceptability, menu diversity, and nutritional requirements of crew. Crop-specific biomass requirements were calculated from menu recipe demands while accounting for food processing and preparation losses. Under the assumption of staggered planting, the optimized menu demanded a total crop production area of 453 m2 for six crew. Cost of the bioregenerative food system is estimated at 439 kg per menu cycle or 7.3 kg ESM crew-1 day-1, including agricultural waste processing costs. On average, about 60% (263.6 kg ESM) of the food system cost is tied up in equipment, 26% (114.2 kg ESM) in labor, and 14% (61.5 kg ESM) in power and cooling. This number is high compared to the STS and ISS (nonregenerative) systems but reductions in ESM may be achieved through intensive crop productivity improvements, reductions in equipment masses associated with crop production, and planning of production, processing, and preparation to minimize the requirement for crew labor.

Biomass↗
PubMed1988

Format and quitting instructions as factors influencing the impact of a self-administered quit smoking program.

This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by-day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self-help booklets were developed for comparison in this study. Each varied on a combination of the two study factors, but were similar in content, length, style, and readability. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigarette smokers who called a stop smoking hotline in Buffalo, New York seeking information on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects reported of being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self-management skills were no more effective than the control booklet (6 month non-smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting.

Adolescent↗
PubMed1991

An evaluation of the Bioself 110 electronic fertility indicator as a contraceptive aid.

The Bioself 110 is a hand-held electronic device that combines the BBT and calendar methods of fertility regulation for planning or preventing pregnancy. A pilot study was undertaken in three centers in the United Kingdom to evaluate the Bioself 110 as a contraceptive aid. This paper deals with 1238 cycles from 131 women. Only one unplanned pregnancy occurred where a volunteer correctly used the Bioself 110 and had intercourse on a supposedly "safe" day. A second pregnancy was experienced by a volunteer who incorrectly used the device and had intercourse on what she though was a "safe" day. Another 11 unplanned pregnancies occurred due to barrier method failures, as well as 11 pregnancies where the volunteers knowingly had unprotected intercourse during the fertile phase. There were five planned pregnancies. The Bioself 110 was correctly used in 71% of the cycles studied. Eighty-four percent of the volunteers indicated that they were satisfied with the Bioself 110 after six to twelve cycles of use. It was concluded that the Bioself 110 can serve as an effective family planning aid and should be added to the menu of contraceptive methods available to women today.

Adolescent↗
PubMed1985

Diet-related knowledge, skill, and adherence among children with insulin-dependent diabetes mellitus.

The dietary adherence of a sample of 97 patients with insulin-dependent diabetes mellitus has been quantitatively described. Now, in an effort to understand the poor dietary adherence found, diet-related knowledge and skill and their relationship to dietary adherence among 90 diabetic children have been studied. Diet-related competencies assessed were the ability to: (1) recall the personal diet plan, (2) correctly fill one's plate from a buffet, with the diet plan in hand, and (3) choose an appropriate meal from a restaurant menu. Adherence to the diet was assessed by unobtrusive observations at meals. Error rates on the three tests of knowledge and skill were .21, .28, and .51, respectively. The mean error rate at mealtime was .35, only slightly higher than the error rate for filling a plate when the children knew they were being tested. In a multiple regression analysis, age (r = .37) and sex (R = .48) were associated with adherence to the diet plan. Ability to choose correctly from a menu, duration of diabetes, and ability to correctly fill a plate from a buffet also entered the regression equation (R = .54). The data suggest that many children did not possess the knowledge and skill required for good dietary adherence, regardless of motivation. Health educators may underestimate the complexity of the behaviors expected of chronically ill patients.

Adolescent↗
PubMed1993

Changing to computerized documentation--plus!

A recent change to a computerized documentation system has had a positive influence on productivity, reliability of documentation, quality assurance, nurse satisfaction and professional practice. This software system combines the care plan and nurses' notes and is standard-based. Each patient's care plan is compiled from Units of Care, which provide a menu covering nursing diagnosis, medical diagnosis, chief complaints and special procedures and events.

Documentation↗
PubMedDate not supplied

Improving patient meal satisfaction with room service meal delivery.

Cancer and cancer therapies cause side effects that prevent patients from consuming adequate amounts of food. As evidenced by patient meal consumption studies conducted at patients' bedside, only 39 percent of patients surveyed consumed greater than 50 percent of their main entree. The Food and Nutrition Services Department at Memorial Sloan-Kettering Cancer Center used the organization's performance improvement process, STRAIGHT-A, to develop and execute a room service program designed to increase patient meal consumption and improve patient meal satisfaction A multidisciplinary task force developed policies and procedures and tested new menu items as part of the room service plan. After program implementation, 88 percent of patients surveyed consumed greater than 50 percent of their main entree.

Cancer Care Facilities↗
PubMed1997

Adaptation of African-American cultural and food preferences in end-stage renal disease diets.

Emphasis on culturally based and ethnically oriented food selection by nutrition health professionals is needed to effectively plan therapeutic diets. With the influx of numerous ethnic groups into the United States and the merging of cultural practices, it is important for dietitians to become familiar with specific ethnic foods and regional cooking techniques. In this review, the influence of immigration on regional cuisine is documented. Dominant patterns of typical African-American ethnic menus for holidays and special celebrations are revealed. Analysis of common foods in the African-American culture are listed for reference, along with a glossary of ethnic foods. Renal guidelines are presented for various stages of end-stage renal disease. When planning a specific renal diet, African-American ethnic preferences can be incorporated into the meal plan or appropriate substitutions can be recommended. A suggested sample menu for hemodialysis patients that incorporates African-American preferences is included for reference. Health risks also influence current eating trends of the African-American population. Hypertension and obesity are two physiological factors that need to be evaluated and considered when planning renal diets. Literacy skills and appropriate dietary instructional material is discussed. Reference materials developed for nutrition professionals are important and can be used in the planning of renal diets for African-Americans.

Black or African American↗