Journal of the Canadian Dietetic Association最新文献

The goals of nutrition intervention in HIV disease include early assessment and treatment of nutrient deficiencies, the maintenance and restoration of lean body mass, and support for activities of daily living and quality of life. The maintenance and restoration of nutritional stores is closely interrelated and interdependent with each of the other recommended medical therapies. Therefore, it is vital to the health of persons with HIV/AIDS to have access to the services of a registered dietitian, who is the essential member of the health care team for providing nutrition care (48). The registered dietitian should take an active role in developing nutrition care protocols for HIV/AIDS in their practice setting. The dietetic professional must take responsibility for obtaining and maintaining current knowledge in this area and take the lead in translating current nutrition knowledge and research into practical and realistic nutrition guidelines for the individual with HIV/AIDS. Further research is needed in the area of HIV/AIDS and nutrition. Registered dietitians and other members of the health care team are encouraged to conduct nutrition research in the area of nutrition interventions and outcomes of nutrition therapy. Additionally, government health related agencies, national AIDS-related organizations, and private industry should be encouraged to provide funding sources and support to the issue of research in nutrition related problems and interventions in HIV/AIDS.

In anticipation of extensive kitchen renovations at Surrey Memorial Hospital, the median elbow height was determined for a group of 49 food service workers. From this measurement, an optimal range for work surface height of 824 mm to 874 mm was determined. This range is lower than that recommended by some ergonomics experts, and lower than the work surface height of much of the existing equipment in Patient Food Services. Work surface height should be considered when equipment is selected or modified as one possible measure to reduce the physical strain of food service work.

We used focus groups to learn the range of issues threatening food security of low income residents in our community. Five major themes emerged from the discussions: literacy, money, time, mental health and self-esteem, suggesting several approaches that could help ensure food security: 1) education, 2) sharing of resources, 3) coalition building, and 4) advocacy. Education programs have to be practical, allowing for demonstrations and hands-on learning while emphasizing skill building and problem solving. Incorporating a social aspect into learning may compensate for the social isolation and would capitalize on the impressive mutual support we witnessed. Strategies based on self-help and peer assistance may counteract low self-esteem and overcome suspicion of health professionals. A community-wide effort is needed to address the factors contributing to food insecurity. We envision the formation of a coalition of professionals, agencies, and low income people to develop a comprehensive strategy for achieving food security.

Although puréed diets are thought to be widely used for patients in long-term care facilities, there is little specific information concerning prevalence and reasons for the actual use of this diet texture. At Saint-Vincent Hospital, a 516 bed, long-term care and rehabilitation facility, 25.9% of the chronic-care population (n = 424) were on a puréed diet. Those who received puréed diets tended to be older (83.5 years versus 75.4 years, P < 0.001) and were more likely to be female (82.7% versus 70.8% P < 0.006), than the total population of long-term care patients. A greater percentage of patients receiving a puréed diet had dementia (43.0% versus 30.6%, P < 0.02), and fewer had cerebrovascular accident as a primary diagnosis (22.6% versus 33.9%, P < 0.05), than the total population of long-term care patients at this hospital. Following data collection, reasons for patients being on a puréed diet were grouped into five categories. The most popular categories were "Physiological/Mechanical" and "Cognitive" problems.

Chart audits are traditionally based on patient charts categorized by disease. An alternate approach, using categorization by four types of nutrition care intervention, has been developed by University Hospital. This paper describes the process followed, criteria developed and the results of two complete chart audits. It was shown that nutrition profile forms improved documentation. Overall norms increased significantly from 81.5% to 90% (p < .05). Discussion centres on the evolutionary process from quality assurance to continuous quality improvement.

Health care in Canada is driven by global economic pressures. Financing solutions will be found through a national strategy for effective quality management of the health care delivery system. Achieving quality effectiveness will demand a new level of accountability and participation in planning from both users and providers. Restructuring and reform will support a shift from disease treatment and from traditional institutions to health promotion and primary care prevention in community based settings. Along with the shift in focus and delivery systems will be new opportunities for dietitians in new roles and in new settings. The specialized knowledge of dietitians, nourishing people under all life's circumstances, is highly valued by society. Now is not a time when dietitians can afford to be passive about our preferred role in the health system. This is a time to learn new skills and to move beyond the role boundaries of the past. This is a time to invest in research that leads to cost-effective, accountable practices.

The breast-feeding practices of Ontario hospitals with live birth rates between 1,500 and 4,000 per year were assessed in 1989 by surveying hospital dietitians. The involvement of the dietitian and/or nurse in hospital based breast-feeding education was determined and differences in hospital practices where dietitians were or were not directly involved in breast-feeding education were assessed. Completed surveys were received from 42 dietitians (84% response rate) of whom 45.5% were directly involved in teaching breast-feeding classes. Practices that could be considered barriers to successful breast-feeding were found in 25% to 60% of the hospitals. The only significant difference between dietitian and nursing directed instruction was that plain water was less likely to be routinely offered to infants when dietitians were involved (p < 0.05). Dietitians will need to become more proactive within the hospital setting by working with health care team members in obstetrics to remove barriers to successful breast-feeding.

Early postoperative feeding (EPOF) practices among North American institutions were investigated using a survey questionnaire to obtain descriptive information regarding the overall utilization and criteria used to identify candidates for EPOF. EPOF was defined as the initiation of enteral nutrition support two to 48 hours postoperatively in major abdominal and thoracic surgical patients. Two hundred and ninety-seven questionnaires were mailed; 170 were completed. Sixty-nine (41%) institutions reported using EPOF. Feeding was initiated less than 12 hours postoperatively in 16% of centres; 84% reported EPOF 13-48 hours postoperatively. The majority (88%) of institutions did not have a specific nutritional guideline for determining which patients should receive EPOF. Objective and subjective nutritional indices, degree of preoperative malnutrition and type of surgery were considered by 23% of respondents when determining the need for EPOF. Percent weight loss, albumin and the anticipated postoperative NPO were considered the most reliable objective indices while decreased dietary intake, cachexic appearance and anorexia were considered the most reliable subjective indices. The results reveal that less than 50% of institutions surveyed use EPOF in major abdominal and thoracic surgical patients and the criteria used to identify candidates for EPOF were found to be variable.

Clinical nutrition services at the Henderson General Division of Hamilton Civic Hospitals has taken a unique approach to standards of care. The Henderson General Division Standards of Care (HGDSC) focus on important issues in the evaluation of care including the goals, intensity and outcome of care. The HGDSC are based on populations defined by the level of nutrition care required and can easily be applied to patients with multiple medical and nutritional concerns. The standards operate under the premise that the process and intensity of care are determined by the goals of care. Thus, the standards assist in the delivery of equitable care to patients of similar nutritional risk. The goal-oriented focus of the standards is a benefit as the impact of nutrition care can be measured using the goals of care as expected outcomes. Outcome measures are considered important in the measurement of quality care since they focus on the patient's health status after intervention. The changing focus of health care in hospitals makes the identification of valid process criteria a priority for clinical dietitians. The purpose of this article is to provide insight into the unique features of the HGDSC and to explore the benefits of standards that focus on the goals and outcomes of nutrition care.