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At least 145 records · Page 8Linked to original sources
PubMed1998

Renal dietitians' perspective: identification, prevalence, and intervention for malnutrition in dialysis patients in Texas.

OBJECTIVE: Determine the prevalence of malnutrition per facility standards; examine interventions used to treat malnutrition; and share experiences, concerns, and solutions to problems in the management of malnutrition in dialysis patients in Texas. DESIGN: Structured survey questionnaires. SETTING: 196 outpatient hemodialysis (HD) and 86 peritoneal dialysis (PD) programs in End-Stage Renal Disease (ESRD) Network of Texas, Inc. PARTICIPANTS: Renal dietitians who worked in Texas dialysis facilities that treated chronic, outpatient adult, and pediatric ESRD patients on HD or PD. MEASIRES: Criteria used to identify malnourished patients, prevalence of malnutrition in dialysis recipients, prevalence and types of interventions used to manage malnourished patients, and participation in quality management activities among renal dietitians. RESULTS: For facilities that treated both HD and PD patients in 1996: (1) a significantly greater proportion of PD patients were identified as malnourished than HD patients; (2) facilities that had a high percentage of malnourished HD patients also had a high percentage of malnourished PD patients; (3) a significantly greater proportion of PD patients received commercial nutrition supplements than HD patients; and (4) use of tube feedings, intradialytic parenteral nutrition, intraperitoneal parenteral nutrition, and total parenteral nutrition among HD and PD patients decreased significantly from the past to the current survey year. Renal dietitians shared their experiences, concerns and solutions to problems in the management of malnutrition in this population. CONCLUSION: Results indicate a need to improve the nutritional status of malnourished dialysis patients, to increase consideration of tube feedings as viable nutrient delivery routes, and to maximize involvement of renal dietitians in the quality management process. With the cooperative effort of staff, care givers, patients, and family, early identification and appropriate interventions may improve the nutritional status and quality of life of dialysis patients. This is a US government work. There are no restrictions on its use.

Adult↗
PubMed2001

Relative validity of a semi-quantitative food frequency questionnaire versus 28 day weighed diet records in Japanese female dietitians.

OBJECTIVE: To assess the relative validity of a semi-quantitative food frequency questionnaire (SQFFQ) against 28 day weighed diet records (WDRs). SUBJECTS AND METHODS: The SQFFQ was administered to 106 (21 male and 85 female) Japanese dietitians in Aichi Prefecture in autumn, 1996 and four-season consecutive 7 day WDRs were carried out during 1996-1997. We evaluated validity of intakes of 15 foods and 31 macro- and micro-nutrients based on the SQFFQ against those according to 28 day WDRs among 79 Japanese female dietitians. RESULTS: Mean daily intakes of selected foods and nutrients determined by the SQFFQ were generally equivalent to those measured by 28 day WDRs. Pearson's de-attenuated correlation coefficients (CCs) with log-transformation and energy-adjustment between intakes of selected foods and nutrients quantified by the SQFFQ and 28 day WDRs (minimum-median-maximum) ranged from 0.17 (beverages)-0.52 to 0.74 (rice), and Spearman's rank CCs with energy-adjustment ranged from 0.28 (confectionery)-0.42 to 0.68 (rice). Respective Pearson's CCs for intakes of nutrients were 0.28 (PUFAs)-0.51 to 0.73 (magnesium), and Spearman's rank CCs ranged from 0.23 (n-3 PUFAs)-0.45 to 0.71 (magnesium). Favorably higher agreement for intakes of foods/nutrients was achieved along with lower disagreement. CONCLUSIONS: Satisfactorily higher relative validity was attained in Japanese female dietitians with the SQFFQ. This calibrated questionnaire seems therefore appropriate for administration to Japanese dietitians to clarify associations between diet and health/disease. SPONSORSHIP: A grant-in-aid from the Ministry of Education, Science, Sports and Culture (06454242).

Adult↗
PubMed2003

Why do diabetic patients not attend appointments with their dietitian?

PURPOSE: Determining the prevalence of and possible reasons for nonattendance of diabetic nutritional care clinics. METHODS: Data were collected by means of a telephone survey and a review of patient records among 293 (166 attendees and 127 nonattendees) patients undergoing outpatient treatment at a university hospital. The t-tests, chi-square tests and logistic regression analysis were used to identify potential determinants of nonattendance. The theoretical framework was primarily based on the Health Belief Model. RESULTS: In univariate analysis, nonattendance at the clinic was associated with a number of factors such as not visiting other care givers, risk perceptions, body-mass index, self-rated health, health locus of control, satisfaction with the dietitian, feelings of obligation to attend, and beliefs about the effectiveness of the treatment. In multivariate analysis only health locus of control and obligation to attend the visit were significant predictors of attendance. A significant number of respondents further reported that they perceived their visits to the dietitian to be of little use. CONCLUSION: One in three diabetic patients undergoing outpatient treatment skipped one or more visits to their dietitian. Patient education to improve attendance should focus primarily on convincing patients that they can contribute to their own health, and may stress the obligation the patients have when making an appointment with the dietitian.

Adolescent↗
PubMed2003

Current practice in the management of children with cerebral palsy: a national survey of paediatric dietitians.

BACKGROUND: Dietitians play a key role in the clinical management of children with cerebral palsy. This survey was conducted with the aim of establishing an overview of current dietetic practice in the management of these children. METHOD: A questionnaire which asked for information on aspects of dietetic practice relating to children with cerebral palsy was circulated to members of the British Dietetic Association during May to October 2000. RESULTS: Many respondents had a small caseload size. However, a larger caseload was linked to membership of a multi-disciplinary team, a greater proportion of severely disabled children and use of a wider range of anthropometric measurements. Dietitians who were members of a multi-disciplinary team were more likely to visit children at home. CONCLUSIONS: This survey provides an overview of current dietetic practice in the UK regarding the management of children with cerebral palsy. There is a potential shortfall in specialist dietitians and this survey highlights some of the gaps in service provision. Children with cerebral palsy benefit from dietetic input and there is an increasing need for specialist dietitians to be involved in their management. It will be necessary to continue to identify any gaps and find ways to overcome them.

Cerebral Palsy↗
PubMed2001

Patients' experiences of a dialysis diet and their implications for the role of the dietitian.

OBJECTIVE: Although developments in medical technology, pharmacology, and nutritional science continue to improve treatment possibilities for patients with renal failure, the level of compliance with medical and dietetic advice remains poor. Previous research on compliance with treatment of chronic illness has led to recommendations for an improved understanding of what is involved in living with chronic illness in order to tailor treatment more appropriately to individual needs. This qualitative study set out to examine, the experiences and difficulties of patients on hemodialysis who follow dietary restrictions, and to ascertain how the dietitian can most effectively support patients in adapting to dietary change. DESIGN: A semi structured interview format with thematic analysis was chosen. SETTING: The interviews took place in the patients' homes and lasted between 30 and 60 minutes. PATIENTS: Participants for the study were approached at Taunton and Yeovil dialysis centres in Somerset, England, and were selected according to the following criteria: (1) all had been on hemodialysis for at least 6 months, (2) all had been advised to follow dietary and/or fluid restrictions at one time, and (3) none had any diagnosed intellectual impairment. Eight subjects were recruited, 4 men and 4 women. The age range was 20 to 68 years. INTERVENTION: Participants were asked to describe in depth their experiences of renal failure and of a renal diet. They were asked what had helped them cope with the difficulties they had faced and how they saw the role of the dietitian. OUTCOME MEASUREMENT: The interviews were recorded, transcribed, and coded according to the following categories: (1) Difficulties experienced by participants. (2) What helped them cope with these difficulties. (3) How the dietitian can help support the coping process. RESULTS: Findings showed a variety of physical, social, and psychological difficulties that can result from the onset of illness, commencement of dialysis, and the imposition of dietary restrictions. A loss of autonomy was an underlying theme. Greater understanding, hope, support from others, individual activity, and personal responsibility on the part of patients helped them to cope more positively with the changes in life. CONCLUSION: Recommendations from this research include ways by which the dietitian can encourage greater autonomy when advising patients, and how they can give information in a positive, sensitive, and supportive way.

Adult↗
PubMed2003

The renal dietitian's role in managing hyperphosphatemia and secondary hyperparathyroidism in dialysis patients: a national survey.

PURPOSE: To survey the medical nutrition therapy practices of renal dietitians for the treatment of bone mineral metabolism. OBJECTIVES: To obtain data on phosphorus diet prescription levels. To determine allied team involvement for phosphate binder and Vitamin D therapies. To assess the frequency and target levels for monitoring serum calcium, phosphorus, -phosphorus product, intact PTH and alkaline phosphatase. METHODS: Two renal dietitians from the National Kidney Foundation-Council on Renal Nutrition developed a 5-question survey. This was posted on both the RenalRD Listserv and the NKF-CRN website from January 1 through February 15, 2001. Dietitians were asked to respond using facsimile, e-mail or reply by mail. RESULTS: One hundred and thirty-one surveys were received representing all major dialysis providers in the United States, the British Virgin Islands, and Japan. Results included information for peritoneal and hemodialysis patients. Five different methods for dosing phosphate binders were determined. Prescribed phosphate binders included calcium acetate, sevelamer hydrochloride, and calcium carbonate. 108 out of 131 dietitian respondents (82.5%) have a medical protocol in place for vitamin D therapy. Of the respondents, 47% were directly responsible for implementing the vitamin D protocol. Paricalcitol was the most widely used form of IV Vitamin D. Biochemistry results were as follows: calcium, 16 different ranges from 8.0 mg/dL to 11.5 mg/dL; phosphorus, 13 different ranges from 2.5 mg/dL to 6.5 mg/dL; calcium-phosphorus product, 13 different ranges from 55-75; iPTH, 20 different ranges from 50-300 pg/mL; alkaline phosphatase, 18 different ranges from no records being monitored to a level of 500 mg/dL. CONCLUSION: The survey revealed a large variability in the treatment of bone mineral metabolism. Improved clinical practice guidelines for the health care team are being developed with the National Kidney Foundation (NKF)-Kidney Disease Outcomes and Quality Initiative (KDOQI) bone disease management workgroup.

Acetates↗
PubMed2001

Use and barriers to use of laboratory data by clinical dietitians.

The results of this study reveal two general areas of concern for clinical dietitians in the use of laboratory data--their lack of confidence in their own interpretive skills and the perceived resistance of physicians. Although clinical dietitians receive theoretical and applied training on the use of laboratory values in their undergraduate education and dietetic internship, clinical managers should be aware that they need support and continuing education to use their laboratory assessment skills to the fullest. Also, dietitians should demonstrate more clearly to physicians their knowledge, skill, and needs in this area. They should initiate and continue dialogue about the importance of laboratory analysis to nutrition care and improved patient outcome. Evidence-based data and clear documentation of improved medical outcomes should help overcome barriers to use of laboratory data by clinical dietitians.

Adult↗
PubMed1986

Role of dietitians in enteral feeding.

Awareness of the nutritional requirements of inpatients has been sadly neglected for many years. Students in British medical schools are taught little about clinical nutrition and the role of the dietitian. Dietitians, on the other hand, spend four years learning the science of nutrition and dietetics. In most hospitals in Britain dietitians are responsible for giving advice on a wide range of therapeutic diets, and only a minority specialize in one particular aspect of nutrition and dietetics. Recent changes and developments in nutritional support have offered an exciting and interesting challenge to dietitians, who with their well established background in nutrition, can play an important part in the nutritional care team.

Allied Health Personnel↗
PubMed1995

Advancing clinical privileges for nutrition support practitioners: the dietitian as a model.

The specialty of nutrition relies heavily on trained practitioners to assess patient nutritional status, define nutritional goals, and recommend therapeutic strategies to achieve those goals. To facilitate the timely delivery of nutrition care, the dietitians at the University of Massachusetts Medical Center expanded clinical privileges. With the support of the Nutrition Department, the multidisciplinary Nutrition Support Service, and the Nutrition Advisory Committee, dietitians write orders for diets, oral and parenteral nutrient supplementation; and custom mix parenteral nutrition solutions, tube feedings, transitional feedings, balance studies, blood glucose monitoring, and home care orders (parenteral and enteral). Dietitians also order laboratory tests such as chemistries, indirect calorimetry, and bone densitometry. Clinical privileges are a permanent part of each dietitian's appointment to the Health Professional Staff and are granted by the Chancellor/Dean of the Medical University.

Dietetics↗
PubMedDate not supplied

Motivational strategies used by dietitians to counsel individuals with diabetes.

The purposes of this study were to determine the use and perceived effectiveness of motivational strategies used by dietitians and to evaluate dietitians' perceptions of barriers to client compliance. A three-part questionnaire with 32 motivational strategies, 16 barriers to adherence, and demographic information was designed and mailed to 862 members of the American Dietetic Association's Diabetes Care and Education Dietetic Practice Group. Statistical analyses included frequency distributions, chi-square analysis, and factor analysis. Only 13 of the 32 motivational strategies were used frequently by 50% or more of the dietitians. The main strategy based on perceived effectiveness was "Tailor the diet to the client's lifestyle." Strategies perceived as effective also were used frequently by a majority of the dietitians. There were differences in use of strategies based on practice setting, CDE certification, and education level. The most significant barrier to adherence was "Complications with lifestyle/competing demands." Factor analysis revealed nine factors for motivational strategies and five factors for barriers to adherence.

Attitude of Health Personnel↗
PubMedDate not supplied

Research activities and interests of dietitians.

A survey was conducted to ascertain research involvement and interests of dietitians. The survey questionnaire was developed and mailed to 1200 dietitian members of The American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.). Usable responses numbered 424 (35.3%); 84% were A.S.P.E.N. members 5 years or less. Currently 46% and previously 17% of respondents served on nutrition support (NS) teams. Two-thirds of the group either completed or were enrolled in a graduate program. Only one-half of the respondents had statistics and/or research methodology courses. Half the group spent no time in research, 10% gave 10-50 hr/week and nearly 80% wanted to spend more time in this activity. One-fifth were principal investigators (PI), 27% were co-investigators and 29% had collected data for others. Although 16% wrote proposals, fewer than 10% had projects approved and/or funded; co-investigators were more successful than PIs in this regard. Several (22.2%) presented research papers or posters and 36% gave seminars, case studies, or short presentations. One-fifth (20.8%) published research articles and 20.3% published other works. More than 80% expressed interest in collaborative research, perhaps because many felt they lacked skills needed to develop research designs, write proposals, analyze data, obtain funding, and get published. Most said research was not rewarded, of a low priority, and generally ignored by the dietetics department; 60.5% had great interest in research and 37.1% had adequate research opportunities. No significant differences were observed for those with graduate degrees or for members of NS teams but A.S.P.E.N. dietitians appeared to be more active in research than other dietitians.

Dietetics↗
PubMed2002

Reproducibility of a semi-quantitative food frequency questionnaire in Japanese female dietitians.

OBJECTIVE: To examine reproducibility of assessed intake of foods and nutrients according to a semi-quantitative food frequency questionnaire (SQFFQ) in Japanese female dietitians. SUBJECTS AND METHODS: An SQFFQ was self-administered to 106 (21 male and 85 female) Japanese dietitians in Aichi prefecture in autumn 1996 and the same questionnaire was repeated in autumn 1997. Reproducibility was evaluated in terms of consumption of 15 foods and energy and 30 macro- and micro-nutrients based on the SQFFQ from 84 Japanese female dietitians. RESULTS: For intake of foods, Pearson's correlation coefficients (CCs) with log-transformation and energy adjustment (minimum-median-maximum) ranged from 0.35 (beverages)-0.61-0.71 (dairy products). ANOVA intraclass correlation coefficients (ICCs) with log-transformation and energy adjustment ranged from 0.49 (beverages)-0.74-0.82 (dairy products). Spearman's rank CCs with energy adjustment ranged from 0.43 (confectionery)-0.57-0.76 (dairy products). Weighted kappa statistics with energy adjustment ranged from 0.34 (confectionery)-0.49-0.71 (dairy products). For consumption of nutrients, Pearson's CCs with log-transformation and energy adjustment ranged from 0.23 (zinc)-0.55-0.74 (insoluble dietary fiber). ANOVA ICCs with log-transformation and energy adjustment ranged from 0.37 (zinc)-0.70-0.84 (insoluble dietary fiber). Spearman's rank CCs with energy adjustment ranged from 0.25 (zinc)-0.56-0.74 (magnesium). Weighted kappa statistics with energy adjustment ranged from 0.25 (zinc)-0.50-0.68 (insoluble dietary fiber). CONCLUSIONS: Substantially high reproducibility of consumption of foods and nutrients was attained from an SOFFQ self-administered to Japanese female dietitians.

Analysis of Variance↗
PubMed1993

An assessment of the need for a dietitian in an out-patient HIV clinic.

People suffering from the acquired immunodeficiency syndrome (AIDS) often experience involuntary weight loss and malnutrition. Altered body composition, recurrent opportunistic infection and a decline in immune function are associated with the progression of the human immunodeficiency virus (HIV) infection to AIDS. The factors that might affect nutritional status in AIDS are numerous and include a reduced food intake, increased metabolism, malabsorption and the acute phase response to infection. It is not clear what difference nutritional intervention can make to the progression of the disease. However, there is a consensus that it has an important role to play during the course of the disease. A report was compiled to assess the requirement for a dietitian in an HIV Clinic (the Southern Alberta Clinic) and the role of the dietitian in that position. Nutritional and anthropometric data were collected from medical records. In addition, Clinic physicians were sent a questionnaire. It was found that clients, when seen by the dietitian, had lost weight and had more gastrointestinal symptoms and a lower CD4+ lymphocyte count than the average Clinic patient at their initial Clinic visit. The report recommended that all Clinic staff use body mass index as a screening tool for referral to the dietitian and that good nutrition be promoted by the Clinic as an important part of the care of the HIV infected person. The assessment recommended a 0.4 full-time equivalent position within the Southern Alberta Clinic.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Dietitians' human resource management skills enhanced by education and experience.

The purpose of this project was to examine the influence of education and experience on the development of human resource management skills in dietitians. The performance of 58 experienced dietitians, 67 entry-level subjects, and 63 undergraduate students was compared using a case study about a personnel problem with a dietitian. Performance was scored by comparing subjects' answers with selections of a panel of seven experienced dietetic managers. Experienced and entry-level groups had higher proficiency scores than students. Experienced and entry-level groups scored highest and students lowest in efficiency, defined as the proportion of total information containing sections chosen that contained helpful information. Experienced dietitians examined few inappropriate sections and students the most. Overall, experienced and entry-level groups performed better in this human resource management problem than students. We conclude that supervised practice is important in the development of human resource management skills.

Dietetics↗
PubMed1986

Perceived needs of Canadian dietitians for continuing education in management.

The purpose of this research was to assess the perceived needs of Canadian dietitians for continuing education in management both currently and as they plan for advancement, career change and development. A self-assessment questionnaire was mailed in January 1985 to 1000 members of the Canadian Dietetic Association (CDA) selected by a systematic randomized technique. Analysis of 450 anonymous questionnaires from employed CDA members showed that 77% were employed full-time and 23% part time. The analysis indicated a profession with a young membership of an eight-year mean and a six-year median in full time practice. A ranked ordering of the types of positions to which dietitians aspired was chief administrative dietitian, consultant, positions in other administration, and then private practice. Personnel and financial management were very important areas for current positions and were expected to be even more so in future. Respondents cited salient factors regarding continuing education programs and prioritized their need for several management topics. These topics were further analyzed according to the present positions of the respondents. This research supports the need for high quality continuing education programs in management for practising dietitians.

Canada↗
PubMed1999

U.S. Army dietitians deploy in support of Cobra Gold: a humanitarian mission.

Dietitians are multifunctional and play an important role in humanitarian missions as educators, planners, and consultants. Three dietitians deployed to Thailand in support of the 16th Annual Joint and Combined Exercise, Cobra Gold 1997. The goal of the Medical Civic Assistance Program (MEDCAP) was to promote long-term public health improvements in rural Thai villages. The dietitians counseled 140 patients and taught an additional 5,300 individuals during nutrition classes. The primary nutrition-related clinical diagnoses included malnutrition, anemia, diabetes, hypertension, goiter, and poor appetite. The dietitian who deployed as the medical planner and MEDCAP executive officer facilitated coordination and planning for all phases of the MEDCAP operation. The teams were made up of U.S. and Thai military forces and Thai civilian medical personnel. The mission requirements were established with the Royal Thai Supreme Command, Thai governors, Ministry of Public Health officers, military and medical officers, and veterinarians of the three provinces.

Dietetics↗
PubMed1975

A decade of Dial-a-Dietitian in Columbus, Ohio.

Data gathered during the decade 1962-1972 on Dial-a-Dietitian as a community service of the Columbus Dietetic Association support the usefulness of this unique experiment in community nutrition education. The image of the dietitian as a spokesman for the science of nutrition and as a contributing member of the health team should be advanced in every way possible. Dial-a-Dietitian is a realistic vehicle which offers much needed assistance. There emerges the need for individualized diet counseling with a fee-for-service and referral from the physician or dentist. Dial-a-Dietitian might then be in a position to direct its enery and resources toward better serving community needs with respect to normal nutrition education. District dietetic associations should define and redefine the objectives to be served by the Dial-a-Diettian program as these relate to specific and changing requirements.

Community Health Services↗
PubMed1975

Malpractice law and the dietitian.

The recent increase in lawsuits against health care personnel makes it advisable that dietitians recognize the potential for legal liability as they practice their profession. Whatever the exact nature of a dietitian's daily duties, an awareness and understanding of the concepts governing the law of malpractice will enable him/her to minimize exposure to liability. To accomplish this, the dietitian should exercise at least a standard of care accepted as competence for the profession. By so doing, the dietitian can insure not only less exposure to malpractice suits, but also attainment of an important goal: delivery of high-quality care to patients.

Diet Therapy↗