Journal of the Canadian Dietetic Association最新文献

Outcome data for patients malnourished due to gastrointestinal problems requiring surgery show that morbidity and mortality are improved when nutrition support is provided. The effect is greatest for those patients whose prognostic nutrition index is high. For these individuals in particular, this support is mandatory for the other therapies provided to be effective. The principle underlying this support is the fact that protein deficit cannot be repaired by carbohydrates or fat, whether from body stores or an external source. Instead, protein has to be provided, either enterally or parenterally. Providing protein as part of nutrition support before, rather than after, the patient deteriorates is the key to improved outcome and cost efficiency. The small percentage of hospital patients who require this intervention can be identified by routine measuring of serum albumin levels and are those with levels below 3.5 g/dL.

The objective of this research was to examine the relationship between quantitative labour productivity in hospital foodservice departments and variations in selected factors such as number of beds, staff turnover and the use of convenience foods. Thirty such factors were tested for their value in predicting labour productivity in the foodservice departments of a sample of public general hospitals in Ontario with rated capacities of 90 or more beds. In this research the outputs of hospital foodservice departments were separated into the two components, goods and services, and then evaluated against the labour required to produce them, given the variations in selected factors. Four of 20 variables tested against the output of goods (mealdays) collectively explained 48% of the variation in number of mealdays produced per labour hour. The four variables were: unionized staff, number of beds, percent patient mealdays of total mealdays, and percent part-time hours of total hours worked. None of 10 variables tested against the output of services (clinical counselling) showed any reliability in explaining the variation in number of patients seen per clinical labour hour.

Integrating scientific changes, citizens' needs and economic constraints has become a challenge. New types of cost-effective services, technologies and products must be found. Manufacturers, hospital administrators and health professionals must be capable of effectively documenting the benefits, risks and costs of their services to society and the quality of care to patients. Choices must be made to decide upon appropriate actions in allocating and using resources. The concepts of cost-benefit analysis and cost-effectiveness analysis should be understood. Identifying and valuing costs and benefits, measuring effectiveness, and assessing quality of life are complex and difficult issues. They are discussed in reference to Canadian studies on the cost-effectiveness of nutrition support. The need for further research to improve cost-effectiveness of nutrition support is stressed.

Malnutrition is associated with an increased risk of both surgical and medical complications; for example, pre-operative nutritional status is predictive of post-operative morbidity and mortality. Such complications result in increased costs to patients and to the health care facility. Studies have shown that nutrition support is associated with fewer complications that can translate into fewer costs. For instance nutrition support is associated with a reduction in mortality, sepsis, hospitalization time and to improve tolerance to radiation therapy. Although more research is required, these studies suggest that indeed nutrition support makes more than sense and can make more than "cents" for the health care delivery system.

Much misunderstanding and confusion exist about the meaning and nature of activities in health promotion. This article examines how our evolving beliefs and concepts about health have led to a new public health, namely health promotion. Health promotion is operationalized using Achieving Health for All: A Framework for Health Promotion.

Fulfilling nutrition support cost-effectively encompasses consideration of the selection of appropriate patients, routes, products and equipment. Properly administered, nutrition support not only benefits the patient but undoubtedly provides a cost-saving to the institution. Data based on product specifications and nutrition needs should be considered in the selection of nutrition products. Standardization of a skeleton solution that can be modified for individual patient needs minimizes associated labour, contains costs and encourages appropriate patient monitoring. The co-ordination of nutrition care by a nutrition support service has been associated with reduced complication rates, improved nutrition therapy and major cost savings.

There are many costs associated with parenteral nutrition: physician time, nursing time, biochemical monitoring, patient education, ancillary equipment and the nutrition solutions themselves. The solutions are easily identified as responsible for a large proportion of these costs. There are several strategies that can be used to help control pharmacy costs, such as selection of ingredients, purchasing contracts, standardized formulae and prescribing procedures, preprinted doctor's order forms, automated manufacturing and labelling processes, patient monitoring, all-in-one preparation, and contracted manufacturing services. Individual pharmacies need to know what options are available in order to select those that, in the context of their own institutions, can lead to cost savings and improved efficiency.

When planning nutrition intervention programs in a health care facility or the community, an analysis of the service population is necessary to determine the levels of care than can be provided. The use of screening and monitoring techniques will maximize the resources that are available and increase the amount of care that can be given. By using baseline nutrition assessment data, health outcomes can be measured over time and cost-effectiveness of the program can be evaluated. Examples of studies that measure effectiveness of nutrition services and programs are reviewed. Specific steps are suggested to simplify the documentation of the process and outcomes of nutrition intervention.

Although the role of the clinical dietitian has undergone dramatic change in recent years, standards for staffing patterns that were developed in 1935 and often still in use. The need for workload measurement systems to quantify the daily activities performed by clinical dietitians led to the development of a new system at the University of Alberta Hospitals in 1984. The workload of clinical dietitians was divided into eight major categories and further divided into 60 activities. A one- or two-week study was conducted four times over an 18-month period. The results indicated that 44 to 54% of the dietitians' time was spent in activities involving direct patient care and team approach. The system has enabled this institution to quantify the workload of its clinical dietitians and may provide a vehicle to measure the impact of major changes on that workload. Since the system covers all possible activities of the clinical dietitian, it may be applicable for use in other institutions. In view of rising health care costs, hospitals must make greater efforts to improve the efficiency of their operations while maintaining the quality of health care services provided to patients. This issue, as it applies to clinical dietetics, was recently addressed by the Nutrition and Food Services Department at the University of Alberta Hospitals.