Journal of the Canadian Dietetic Association最新文献

The computerized dietary assessment system developed at Chedoke-McMaster Hospitals, to assist dietitians with routine calculation of nutrient intakes of patients, as a component of clinical nutrition assessment is described. The program was designed for dietary assessments of hospitalized patients and ambulatory patients, and to facilitate teaching students about dietary management of medical nutrition problems. To meet program objectives, efforts were directed toward software development, with flexibility to meet the needs of a wide variety of users, to accommodate rapidly changing nutrient composition data, to allow tailoring of the database to individual clinical settings, and for future expansion. The regionally accessible dietary assessment system is easy to use and is rapid, requiring 10 to 15 minutes to complete each one-day assessment. The program has been well accepted and utilized by hospital nutritionists in several clinical areas, for establishing dietary goals, monitoring progress, and in patient education.

Surveys were conducted to assess the computer use in 50 selected Canadian health care foodservice facilities and to determine the educational preparation for computer use in seven selected Canadian post-secondary education institutions which educate potential foodservice personnel. Both the foodservices and post-secondary educational institutions selected were represented at two workshops on computer-assisted foodservice management held in June 1980 and in May 1981. Only seven facilities used a computer for foodservice functions; nine foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. Only one post-secondary educational institution actually had an educational foodservice application for student use. The other six educational foodservice facilities covered the subject matter content by readings, lectures and discussions.

This article describes the improvements made by a dietitian in two long term care facilities. Neither facility had previously employed a dietitian. Nutritional status of residents was improved by menu revisions that included more dairy products. Accurate serving of calculated diets was instigated. Administrative tools such as policy and procedure manuals and standardized recipes were introduced. It is to be hoped that the positive experiences of these long term care facilities in employing dietitians will encourage other facilities to follow suit.

Low protein diets are used to treat infants and children with hyperammonemia due to urea cycle and other metabolic disorders as well as a number of amino and organic acidopathies. The incidence of these disorders is small and many are life-threatening. As a result, there is little in the literature on the dietary management of these patients. This paper draws on 10 years of clinical experience at the Hospital for Sick Children in Toronto, Ontario and presents a guide to the preparation of infant formulas providing levels of protein intake from 0.5 to 2.0 g per kg. Also described is a low protein equivalency system that is a useful guide for measuring both baby foods and table foods for affected children up to about six years of age. This dietary information is accompanied by a description of the disorders amenable to low protein diets, some of the adjunctive therapies employed and the nutritional concerns associated with severe restriction of protein.

The Maternal and Child Health Program Kit has been developed to prepare and support parents in the postpartum. The kit responds to four objectives: to help families to get to know their babies; develop feelings of competence; set realistic expectations for the postpartum; and to identify and use supports and resources. In developing the kit, two target groups have been identified--the primary group, the parents; the transmitter group, the educators. The kit includes question booklets at the bedside that encourage mothers to ask questions; resource cards for health professionals that facilitate consistency in information giving; information sheets to provide concise information on topics that cover detailed information or emotional areas; four slide-tape shows on breastfeeding and a coloring book for siblings. The Maternal and Child Health Program Kit is currently being evaluated.

The Phenylalanine Content of Foods, an equivalency system used in the dietary treatment of phenylketonuria, was prepared in 1975. Recently this system was revised to include a total of 372 food items in various raw and processed states. Food lists are available in a simple version for parents listing the serving size per phenylalanine equivalent, and in a more comprehensive version for dietitians providing weights for the serving sizes as well as values for phenylalanine, protein, and energy per equivalent. Subsequently, the system was modified to form a low protein equivalency system for use in designing low protein diets for a number of other inherited metabolic disorders.

Five axioms of learning explain the stability of dietary practices and suggest approaches to teaching more healthful habits. These axioms include the influence of prior beliefs and attitudes upon people's interpretations, the fact that effective learning is incremental, the value of reinforcement, the habitual nature of much behavior, and the fact that learning includes both cognitions and skills. The Health Belief Model (HBM), a specification of the first axiom, holds that people are likely to follow health recommendations if they are motivated about their health and if they believe that they are susceptible to an ill health condition; that the occurrence of that condition would have serious impact on their lives; that following a particular set of health recommendations would be beneficial in reducing either their susceptibility to or the severity of the condition; and that the psychological benefits of following the health recommendation outweighs its costs. Educational diagnosis may be made by identifying peoples' status on each variable in the HBM and then formulating an educational plan directed toward modifying beliefs, as needed, taking into account the other learning axioms. An ethical stance is adopted that holds that informed individuals should be entitled to maintain the practices they prefer.

A survey was conducted to assess the computer use in 27 selected Canadian health care food service facilities and the educational needs in computerization of the corresponding foodservice administrators. The foodservices selected were represented by foodservice administrators at a workshop on computer-assisted foodservice managements held in June 1980. Only three facilities used a computer for foodservice functions: seven foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. The foodservice administrators identified their educational needs in computerization and demonstrated that a one to two day workshop was their preferred educational program format.

Simulating volume demand within hospital food service departments, infrared heat processing conditions were used to heat two similar protein menu items to determine both energy consumption required for heat processing and energy/nutrient rations. A larger, conveyorized infrared oven (CTX-70) and a smaller, infrared unit (Krups 2002) were used to heat process varying sizes of oven loads which ranged from one to 36 slices. Although no significant differences were found for product yield after 12, 24 and 36 slices were heat processed in the CTX-70, the energy usage was significantly different: 637, 798 and 1005 watt hours/load were consumed, respectively. In the Krups 2002, a load of one slice had greater heat processing losses than either two or four slices. Energy consumption was 39, 47 and 50 watt hours/load to heat process one, two and four slices in the Krups 2002, respectively. Significantly more energy was used to heat process turkey-ham than egg sandwich loaf in the Krups 2002. The potential use of energy/nutrient rations by dietitians was discussed.