Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DIETICIANS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2006

Assessing nutritional status in chronically critically ill adult patients.

BACKGROUND: Numerous methods are used to measure and assess nutritional status of chronically critically ill patients. OBJECTIVES: To discuss the multiple methods used to assess nutritional status in chronically critically ill patients, describe the nutritional status of chronically critically ill patients, and assess the relationship between nutritional indicators and outcomes of mechanical ventilation. METHODS: A descriptive, longitudinal design was used to collect weekly data on 360 adult patients who required more than 72 hours of mechanical ventilation and had a hospital stay of 7 days or more. Data on body mass index and biochemical markers of nutritional status were collected. Patients' nutritional intake compared with physicians' orders, dieticians' recommendations, and indirect calorimetry and physicians' orders compared with dieticians' recommendations were used to assess nutritional status. Relationships between nutritional indicators and variables of mechanical ventilation were determined. RESULTS: Inconsistencies among nurses' implementation, physicians' orders, and dieticians' recommendations resulted in wide variations in patients' calculated nutritional adequacy. Patients received a mean of 83% of the energy intake ordered by their physicians (SD 33%, range 0%-200%). Patients who required partial or total ventilator support upon discharge had a lower body mass index at admission than did patients with spontaneous respirations (Mann-Whitney U = 8441, P = .001). CONCLUSIONS: In this sample, the variability in weaning progression and outcomes most likely reflects illness severity and complexity rather than nutritional status or nutritional therapies. Further studies are needed to determine the best methods to define nutritional adequacy and to evaluate nutritional status.

Adult↗
PubMed1996

[Dietary treatment of mild to moderate hypercholesterolemia. Effectiveness of different interventions].

OBJECTIVE: To compare the efficacy of brief dietary intervention by family physicians in their daily practice and in group sessions to standard dietetic treatment in mild to moderate hypercholesterolemia. DESIGN: Randomised clinical trial. SETTING: Family practice clinic in a remote community. PARTICIPANTS: Between September 1, 1991 and September 30, 1992, 135 men and women between 20 and 60 years old with mild to moderate hypercholesterolemia were recruited and randomly assigned to three treatment groups to be taught the American Heart Association low fat diet. Each participant had an LDL-C reading higher than the desirable level set by the Canadian Consensus Conference on Cholesterol. INTERVENTIONS: The three treatment groups received different interventions: individual consultations with a family physician in his office (phase I); group sessions with a physician and a dietician (phase II); and individual consultations with a dietician (phase II). Participants were followed for 6 months with visits and blood tests every 2 months. MAIN OUTCOME MEASURES: Reduction in serum levels of total cholesterol, LDL-C, HDL-C, and triglycerides was measured after 2, 4, and 6 months of dietary treatment. Changes in risk factors (smoking, weight, level of physical activity) and patients' cholesterol/saturated fat index were also measured. RESULTS: Ninety-nine subjects completed the 6-month regimen. The mean reduction in serum LDL-C was 0.08 mmol/L (1.8%) in Group I, 0.07 mmol/L (1.6%) in Group II, and 0.28 mmol/L (6.3%) in Group III (P = 0.94). An LDL-C reduction of 10% or more relative to initial level was observed in 27% of participants in Group I and approximately 40% of subjects in the other two groups (P = 0.41). Counseling resulted in a decrease in body weight, smoking, and dietary fat consumption and an increase in physical activity. CONCLUSIONS: Treatment by a dietician achieved better results and should remain the standard. Physicians should focus on the detection and control of other heart disease risk factors.

Adult↗
PubMed1998

[Differences between diabetes mellitus type 2 patients switched and not switched over to insulin treatment after specialist consultation].

OBJECTIVE: To describe the characteristics of patients with diabetes mellitus type 2 who were referred to an outpatient department for insulin therapy. SETTING: Hospital De Weezenlanden, Department of Internal Medicine, Zwolle, the Netherlands. DESIGN: Descriptive. METHOD: Referred patients with diabetes mellitus type 2 visited a diabetes team consisting of internist, diabetes specialist nurse, dietician, and ophthalmologist. After maximizing oral therapy according to the dosage scheme of the national guidelines of the Dutch College of General Practitioners, patients were switched over to insulin therapy if glycaemic regulation remained poor. After improvement and stabilisation of glucose values, patients were discharged to their general practitioners. Initial baseline characteristics of those who were switched over to insulin therapy within 6 months and those who were not were compared. RESULTS: Forty-eight men and 51 women were included. Mean age was 61.2 years (SD: 10.9) (range: 31-84) with a mean duration of diabetes of 8.9 years (SD: 8.3). Oral hypoglycaemic agents (OHA) had been used for 6.7 years (SD: 5.4). Mean glycohaemoglobin content was 10.4% (SD: 2.7) and 47 patients had hyperglycaemic complaints at baseline. Patients switched over to insulin within six months (n = 60; 61%) differed significantly from the non-insulin group (n = 38) in glycohaemoglobin (10.9% (SD: 2.5) versus 9.6% (SD: 3.0)), duration OHA use (7.7 years (SD: 5.6) versus 5.0 years (SD: 4.5)), and body mass index (26.5 kg/m2 (SD: 3.9) versus 29.1 kg/m2 (SD: 5.6)). In women, only the body mass index was significantly different. Main reasons for not switching over to insulin were achieving acceptable control by optimizing OHA, education by diabetes specialist nurse and dietician, treatment of underlying disease or acceptable glycohaemoglobin percentage at baseline. Within six months 62 patients (63%) were discharged to their general practitioners. CONCLUSION: Referral to secondary care led to improved glycaemic control through maximizing oral therapy, education by the diabetes specialist nurse and dietician, switching over to insulin and diagnosis and treatment of underlying disease.

Adult↗
PubMed1985

A prospective comparison of 'conventional' and high carbohydrate/high fibre/low fat diets in adults with established type 1 (insulin-dependent) diabetes.

Diabetic associations throughout the world are recommending high carbohydrate/high fibre/low fat diets for diabetic patients as a means of improving general health and metabolic control. We have previously shown that the efficacy of a 'conventional' low carbohydrate diet can be greatly increased by improving the method of dietary education. To test whether further improvement in metabolic control could be achieved by changing to a high carbohydrate/high fibre/low fat diet we have followed a group of 40 Type 1 (insulin dependent) diabetic adults for up to 19 months. They had all been prescribed a conventional low carbohydrate diet taught by one of three methods (dietician only, practical lunchtime demonstration or videotape). Those taught by dietician only were left as a control group for follow-up (group A). The others were randomized either to continue on their present diet (group B) or to change to a high carbohydrate/high fibre/low fat diet (group C). At final assessment those in groups B and C were more knowledgeable, compliant and better controlled than group A. Those in group C achieved a change from 38% carbohydrate/43% fat/20 g fibre daily to 45% carbohydrate/34% fat/32 g fibre daily. However, metabolic control in group C deteriorated while taking the high carbohydrate/high fibre/low fat diet (haemoglobin A1 went from 9.4 +/- 0.5% to 11.2 +/- 0.5%, p less than 0.01, over 4 months). None of the patients in group C changed their eating habits or those of their families nearly as much as was recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland.

BACKGROUND & AIMS: Nutritional support teams (NST) have been demonstrated to be an excellent mechanism for identifying patients in need of nutrition support, improving the efficacy of nutrition support in a variety of hospital environments. Focus of this study was the investigation of function, structure and organisation of NST in Germany (D), Austria (A) and Switzerland (CH). METHODS: Prospective investigation of the function, structure and organisation of NST in D, A and CH, using standardised questionnaires. RESULTS: From a total of 3071 hospitals in D, A and CH, NST have been established at 98 hospitals (3.2%). Their main activities were creating nutritional regimes (100%), education (87%) and monitoring nutrition therapy (92%). In general, the NST are not independently operating units but are affiliated to a special discipline. Seventy-one per cent of the physicians, 40% of the nurses and 69% of the dieticians in the NST held a nutrition-specific additional qualification. A total of 12% of the physicians, 37% of the nurses and 46% of the dieticians are exclusively responsible for the NST. A reduction of complications (88%) and cost saving (98%) were indicated since their establishment. The NST received in 32% funding support. CONCLUSION: In D, A, CH neither a uniform nor comprehensive patient care by NST existed in 2004. Standards of practice, development of guidelines in clinical nutrition and better documentation in NSTs are necessary. Special efforts should be aimed at education of NST members and financing of teams.

Austria↗
PubMed2006

A method for implementation of nutritional therapy in hospitals.

BACKGROUND AND AIMS: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening guidelines. METHODS: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Pre-measurement: assessment of quality goals prior to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) INTERVENTION: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning nutrition, elaboration of an action plan and implementation of the plan. (3) Re-measurement: as in (1) based on information from records and patient interviews, and an evaluation based on focus group interview with the staff. Patients who gave informed consent to participate in the study (>14 years) were included consecutively. Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson chi(2) test for nominative data. P values <0.05 were considered significant. The study was performed in accordance with the Research Ethics Committee. RESULTS: In this study 141/122 patients were included before/after the implementation period with a mean weight loss within the last 3 months of 6.2 and 5.2 kg, respectively. Before the study we found that BMI was not measured. More than half of the patients had a weight loss within the last 3 months, and 40% had a weight loss during hospitalization, and this was not documented in the records. About 75% had a food intake less than normal within the last week, and nearly one-third were at a severe nutritional risk, and only 33% of these had a nutrition plan, and 18% a plan for monitoring. Barriers concerning nutrition included low priority, no focus, no routine or established procedures, and insufficient knowledge, lack of quality and choice of menus, and lack of support from general manager of the hospital. The staff introduced individually targeted procedures including assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dieticians and special diets, communication, and educational programs. A great consistency existed between barriers for targeted nutrition effort and ideas for improvement of the quality goals between the different departments. Quality assessment after study showed an overall significant improvement of the selected quality goals. CONCLUSION: The introduction of a new method for implementation of nutritional therapy according to ESPEN screening guidelines seems to improve nutritional therapy in hospitals. The method included assessment of quality goals, identification of barriers and individual targeted plans for each department followed by an evaluation process. The model has to be refined further with relevant clinical endpoints.

Aged↗
PubMed2001

[Nutritional status and risk in hospitalized children].

BACKGROUND: A few studies report malnutrition in hospitalized patients. MATERIAL AND METHODS: This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. RESULTS: Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. CONCLUSIONS: Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

Body Mass Index↗
PubMed2001

Food consumption patterns in Italy: the INN-CA Study 1994-1996.

OBJECTIVES: The present study was aimed at surveying the Italian food consumption patterns in the 90s. It represented the second nationwide food intake survey that was carried out by the Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN). DESIGN: Cross-sectional study. SETTING: Free-living households. SUBJECTS: Sampled subjects: 1147 households randomly selected to be representative of the four main geographical areas (North-West, North-East, Centre, South). Analysed subjects: 1978 individuals out of 2734 initially collected in 15 Collaborative Centres strategically scattered through the national territory. METHODS: A mixed 7-day based survey technique was applied in order to survey both individual and household consumption. At individual level, food intake was recorded by a self-compiled diary. At household level food data collection was by compilation of a food inventory by the dietician, a purchased/wasted foods diary and a recipes form both compiled by the person responsible for food related activities (decision of purchase, purchase, preparation of meals) in the household. All recorded data were monitored by the dieticians who visited the households participating in the study, at least three times. Household members were interviewed in order to collect socio-demographic, lifestyle and motivational information. Furthermore, field-workers performed the food coding and the input of data by an ad hoc developed software. The survey design allowed an internal quantitative check of food data. Several check steps were centrally performed RESULTS: The complex methodology caused the 46.8% response rate and afterwards a reduction of the analysed units (72% of the surveyed individuals). However, the analysed sample provided sufficiently reliable data for outlining the most relevant aspects of dietary patterns in Italy. In order to better interpret the results, controversial aspects are also illustrated and discussed in the text. The disparity analysis found that traditional diversities among Italian regions are still alive. In general, males eat more than females. Analysis according to the age class (children: 1-9 years old; adolescents: 10-17; adults: 18-64; elderly: >64) showed differences especially between the group of children vs all the others, but also in the two groups of young individuals vs adults and the elderly, that could represent clues of an incorrect way of eating. CONCLUSIONS: Taking into account the different methodology, the comparison with previous results showed changes in the Italian average diet complying with an increasing attention to healthy aspects by large sectors of the population, but also opposite tendencies that should be carefully monitored. SPONSORSHIP: Minister delle Politiche Agricole e Forestali (Mi.P.A.F.).

Adolescent↗
PubMed2001

Towards implementation of optimum nutrition and better clinical nutrition support.

Clinical Nutrition Support--defined as nutrition for hospitalized patients suffering from metabolic stress--plays a limited role in the therapeutic routine of the physician. This is not surprising as most research in the field of clinical nutrition is disappointing with regard to the objective outcomes: morbidity and mortality. These reflections advocate a more 'pharmaceutical approach' to nutrition in order to perform more proper studies on the potential effectiveness of this treatment modality. To provide all patients in the Academic Medical Centre (AMC) in Amsterdam, The Netherlands, with optimum clinical nutrition support, a Nutrition Support Team (NST) was established in 1996. This NST is coaching the dieticians and physicians in the AMC regarding clinical nutrition support. In practice this coaching consists of providing clear guidelines on what is supposed to be optimum nutrition, a basic course in parenteral nutrition and further continuous education. The concept of optimum nutrition is spread by the NST through various ways of education, both nationally and internationally. For adults, optimum nutrition is defined as the amount of protein, that stimulates whole body protein synthesis maximally (1.7 g/kg actual body weight) and covers anabolic energy need (35 kcal/kg actual body weight). The dietician is considered to be the expert in the field of optimum nutrition by oral, enteral or parenteral route. The Dietetic Department has increased its influence in the care of the patient by placing nutritional status and care on the chart of the patient's treatment. To provide optimal Nutrition Support for children and severe ill patients (Intensive care department) specialized teams were started which were co-ordinated by the central NST. The central NST has a co-ordinating and educating role, while the Specialized Nutrition Support Teams (Specialized NST) construct guidelines, undertake research and provide continuous optimum nutrition care.

Dietetics↗
PubMed2003

Evaluation of equity in diabetes health care in relation to African and Caribbean ethnicity.

OBJECTIVE: Many US studies have shown that ethnic minority groups have less access to health care. We evaluated whether black African and black Caribbean people with diabetes in the UK gain access to diabetes health care on an equitable basis compared with white people. DESIGN: Cross-sectional questionnaire survey set in 29 general practices in south London. Main measures were self-reported morbidity, SF-36 scores and utilisation of health care. Analyses of utilisation variables were adjusted for age, sex, ethnic group, duration of diabetes, and socio-economic and health status. RESULTS: There were 1,899 respondents (64%) from 2,983 individuals registered with diabetes. These included 799 white, 522 black Caribbean, 163 black African and 415 other subjects with type 2 diabetes. After adjusting for need, black Caribbeans reported higher utilisation of health care than white subjects for four of nine utilisation variables, and black Africans for two. For the remaining variables utilisation was equivalent in different ethnic groups. Black Caribbean subjects were more likely to be treated for hypertension if hypertensive (odds ratio 1.84, 95% CI 1.05 to 3.22), to use blood or urine self-monitoring (1.40, 1.04 to 1.88) and to have attended a diabetes nurse (1.34, 1.04 to 1.74) or dietician (1.49, 1.19 to 1.86). Black Africans were more likely to have attended a dietician (2.15, 1.40 to 3.29) or an ophthalmologist (1.72, 1.10 to 2.70) in the past year. CONCLUSION: There was no evidence from this study that black African or black Caribbean subjects had less access to diabetes health care in relation to need.

Adult↗
PubMedDate not supplied

Nutritional awareness of critically ill surgical high-dependency patients.

It has been recognized that malnutrition in hospital is a serious problem that may go undetected. There is growing evidence that early nutritional support in high-risk patients helps reduce postoperative complications; however, malnutrition is often diagnosed only once it is well established. This study showed that, both retrospectively and prospectively; there were no formal nutritional assessments of patients in a high-dependency unit (HDU), that time to feeding was generally within the recommended 5-7 day postoperative period, and that the most common form of supplementary feeding was total parenteral nutrition (TPN). Prospectively, the choice of supplementary feeding was dependent on the type of surgery and the individual patient's condition. Since this study was completed, a dietician has been allocated to the HDU and carries out formal nutritional assessments on a daily basis. Further research is required to assess the impact of the dietician on patient nutrition.

Activities of Daily Living↗
PubMed2003

[Dietitians' understanding of personalized nutritional guidance--proposals to increase home visits by dietitians].

Providing elderly people with nutritional care has become important. The aim of the present study is to clarify the factors limiting the widespread adoption of home visits by dietitians. From September to November 2002, we conducted a questionnaire survey of 211 dietitians belonging to the "Houeiken", a group devoted to the study of dietician's home visits. We examined the following factors: characteristics of the study subjects, result of the home visits, factors limiting the widespread adoption of home visits by dietitians, and the future of home visits by dietitians. Among the dietitians, 49.7% did nutrition management, 30.5% catering management and 12.8% performed home visits (12.8%). In total, 53.5% of the dietitians had experience with home visits, having visited an average of 1 to 5 people. Typical visits included cooking lessons (27.5%), advice on energy intake (25.3%), sharing new recipes (23.6%), and anthropometric examinations (13.3%). A total of 76.8% thought their guidance was effective and noted significant improvements in terms of caregiver's cooking skills (30.0%), patient's understanding of diet (24.0%), and dietary intake (21.5%). The factors preventing more widespread home visits by dietitians are: few people are aware that this service exists, few people believe that they need this type of assistance, it is largely unprofitable, and the number of qualified dieticians is insufficient. We believe that more medical staff should become involved in dietitian's home visits. Public policies should be implemented to lower dietitian's nutritional care fees and increase the education and number of dietitians.

Aged↗
PubMed2006

[The role of a multidisciplinary approach in geriatric care and rehabilitation from the acute to the chronic stage].

A multidisciplinary team for bed sores consisted of 10 members including 3 dermatologists, 3 nurses, 1 physical therapist (PT), 1 pharmacist, 1 dietician, and 1 medical clerk. The incidence of new bed sores after admission was significantly decreased from 3.31% in 2003 to 1.04% in 2005 (P < 0.01). A total of 324 percutaneous endoscopic gastrostomy (PEG) procedures were performed from 2001 to January 2006. Among those, the survival of 172 elderly patient (aged 65 years or older at the time of PEG) was calculated by the Kaplan-Meier method. The 30-day mortality rates was 11%, and the 1-year, and 5-year survival rates were 61.2%, and 34.4% respectively. After discharge, 40 patients were followed up at the PEG clinic in our hospital whose staff consisted of 1 expert surgeon, 5 nurses and 1 dietician. When compared with 67 patients transferred to other hospitals or nursing homes, the patients in the PEG clinic showed a significantly longer survival (P < 0.01, 44 versus 29 months). A full-time integrated treatment (FIT) program for stroke rehabilitation was developed in the Nanakuri-Sanatorium of our university in 2000. Eighty-one stroke patients were on the FIT program during their hospital stay and achieved significantly higher activities of daily living (ADL) scores (P < 0.01) at discharge assessed by functional independence measure (FIM) compared to 41 patients on previous rehabilitation program. In addition, their ADL scores were maintained significantly higher (P < 0.05) even at 18 month after discharge, which might help them to stay home independently or with less care burden. These results suggest the important role of multidisciplinary approach for geriatric care and rehabilitation.

Activities of Daily Living↗
PubMed2001

[Multidisciplinary management of the obese patient: example from the Obesity Center at the University of Liege].

Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The new "Centre de l'Obésité" at the University of Liège aims at fulfilling such objectives with: 1) a first outpatient visit including the simultaneous participation of an endocrinologist, a dietician and a psychologist; 2) a structured and individualized programme of physical rehabilitation; 3) an individualized management of obese subjects as in-(hospital) and/or outpatients, using medical and/or surgical approaches; and 4) an opportunity to benefit of other specialized medical advices, if necessary, in order to increase both the efficacy and safety of the treatment. Owing to the increasing importance of obesity and the well-known difficulties to succeed in treating it, general practitioners should consider this new centre as a valuable help rather than a competitive structure for the management of their patients, especially those with severe or morbid obesity.

Counseling↗
PubMed2001

[Standards, options and recommendations: Good clinical practice in the dietetic management of cancer patients: hospital catering].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, involves a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Regional Cancer Centres, some French public university and general hospitals and private Clinics and medical scientific societies. Its main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on a literature review followed by a critical appraisal by a multidisciplinary group of experts to produce the draft guidelines which are then validated by specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for hospital catering for cancer patient using the methodology developed by the Standards, Options and Recommendations project. METHODS: Data were identified by a literature search of Medline and the reference lists of experts in the groups. After the guidelines were drafted, they were validated by independent reviewers. RESULTS: The main recommendations are: 1) While taking into consideration the specific needs of cancer patients, the dietician is responsible for the hygiene, the sanitary quality of alimentation, the equilibrium and nutritional quality of the hospital catering. 2) Ordering and distribution of meals, and clearing up afterwards contribute to the quality of hospital catering and the personnel who do this should have time and be willing to listen to the patients. 3) The ordering of meals should be adapted to individual patient's requirements and must take into account the patient's medication. 4) The method of transporting the food chosen by the institution (cold or warm method) should be respected. The personnel responsible should receive regular and specific training to use the method correctly. 5) The intake of patients with nutritional follow-up should be reliably and reproducibly evaluated by the personnel after every meal. 6) Patient satisfaction should be assessed once a year and the results of this assessment used to improve the quality of hospital catering. 7) The dietician is the interface between the accounts department, the medical wards, the hospital catering department and the patients.

Adult↗
PubMedDate not supplied

Phosphate control in chronic uremia: don't forget diet.

Control of the phosphate balance is a major concern for chronic dialysis patients and it depends on dietary intake, intestinal binding and dialytic removal. Phosphorus mass transfer through dialysis and new phosphorus binders have been widely investigated, but negligible attention has been given to dietary phosphorus management, because of the problems of poor compliance and conflict with the recommended high protein intake. The nutritional target in dialysis patients should be a diet supplying adequate protein but limited phosphate intake, without dramatic changes of dietary habits and lifestyle. It is important to educate patients regarding phosphorus content of current foods so that foods providing less phosphorus with the same protein content can be selected, thus preventing dietary phosphate overload. On the basis of a three-day dietary record, dieticians should give the patient personalised advice in order to reduce phosphorus intake while ensuring the desired protein and energy intake. Dietary manipulation may have little impact on the dialysis population but in individual patients dietary counselling can greatly improve phosphate control. Close co-operation between nephrologists and dieticians is needed to motivate patients and ensure compliance, if dietary intervention is to succeed. All patients should be given dietary education and counselling, especially young-adults, because dietary phosphate control is an important component of an integrated therapeutic approach to phosphate retention and hyperphosphatemia in end-stage renal disease.

Diet↗
PubMed2003

Self-administration of epinephrine in children: a survey of current prescription practice and recommendations for improvement.

The prevalence of peanut allergy is increasing rapidly and many children are now prescribed self-injectable epinephrine as part of their management. We aimed to examine the current extent of self-injectable epinephrine dispensing to children in the Eastern Health and Social Services Board (EHSSB), Northern Ireland, including indications for prescription, investigations performed, information and training provided and actual usage. Dispensing records held by the EHSSB were examined for the period May to August 1998. All general practitioners prescribing 'Epipens' during this period were contacted and asked to identify the patient and provide contact details. Information was gathered using postal questionnaires sent to General Practitioners and parents. A total of 104 'Epipen' prescriptions were dispensed. Thirty-seven (36%) general practitioners responded to the initial questionnaire; of these 36 (35%) were suitable for analysis. Thirty-four parents were then contacted; 28 (82%) returned questionnaires were reviewed. The commonest indication for 'Epipen' prescription was peanut allergy (32 of 36 (89%) general practitioner responses; 25 of 28 (89%) parent responses). Twenty-six (72%) children had been seen by a specialist; all except one had either blood or skin tests. Six of the remaining eight children had no investigations. General practitioners reported 14 (39%) parents to have basic life support training, compared with six (21%) parents. Eighteen (64%) parents had been given written information regarding their child's allergy, nine (32%) had been referred to a dietician and seven (25%) children wore a medical warning bracelet. The Epipen had been used by three children; all three had multiple food allergies. This study has identified a great variability in the management of children with allergy including the need for specialist referral, further investigation, written allergy advice, referral to a dietician and formalised training in basic life support and administration of epinephrine. It suggests a lack of consensus amongst health care professionals as to the best practice in the management of potentially life threatening food allergy and indicates, at least, a need for better multidisciplinary communication.

Adolescent↗
PubMed2005

Dietary dilemmas in diabetes.

BACKGROUND: Two of the 'f' words summarising predisposition to type 2 diabetes are fixed (family history, age forty years), but the third (fat) can be changed. The diagnosis of diabetes can be the trigger to review lifestyle, 'eat less and walk more' and to lose fat tissue. Initially this is often enough to bring blood glucose into the target range, but later as the metabolic abnormality of type 2 diabetes progresses, oral hypoglycaemic agents will be needed. Nonetheless, lifestyle issues remain important in managing the medical components of the type 2 syndrome (blood glucose, blood pressure, blood fats and blood clotting). OBJECTIVE: This article uses a case based approach to discuss how a dietician can help patients review and modify their lifestyle. DISCUSSION: A coordinated approach by the general practitioner, dietician and diabetes educator will often help to discover the cause of abnormal blood glucose levels, and assist the patient in normalising them.

Diabetes Mellitus, Type 2↗