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Biomedical subjects

A Skipper

Publications and source records attributed to A Skipper.

14 recordsLinked to original sources
PubMed1997

The role of nutrition support dietitians as viewed by chief clinical and nutrition support dietitians: implications for training.

OBJECTIVES: To determine current and ideal frequencies with which nutrition support dietitians perform each item on a list of 15 tasks and evaluate dietitian preparation for the practice of nutrition support. DESIGN: Data were collected using two questionnaires, one completed by the chief clinical dietitian and the other completed by the nutrition support dietitian at each hospital surveyed. Both versions of the questionnaires contained a list of 15 tasks that had been validated as being related to advanced nutrition support by a panel of 20 nutrition support experts using a modified Delphi method. Follow-up telephone calls were made to increase the number of responses. SAMPLE: Questionnaires were mailed to the chief clinical dietitian at 300 randomly selected, general medical/surgical hospitals with 300 or more beds in the United States and Puerto Rico. A total of 134 chief clinical dietitians (45%) and 129 nutrition support dietitians (43%) responded to the surveys; 124 (41%) and 120 (40%) questionnaires, respectively, were usable for statistical analyses. STATISTICAL ANALYSES: The Wilcoxon matched-pairs signed-ranks test was used to determine differences between nutrition support dietitian actual and ideal frequencies and between chief clinical dietitian actual and ideal frequencies for each of the 15 tasks. The Mann-Whitney U-Wilcoxon rank sum W test was used to determine differences between nutrition support dietitian and chief clinical dietitian actual frequencies and between nutrition support dietitian and chief clinical dietitian ideal frequencies for each of the 15 tasks. Descriptive statistics were used to analyze the questions regarding educational preparation for nutrition support practice and demographic data. RESULTS: The ideal frequency for each of the 15 tasks was significantly greater (P < .0001) than the actual frequency reported by nutrition support dietitians and chief clinical dietitians. Whereas chief clinical dietitians and nutrition support dietitians agreed on the ideal frequency for most tasks, the nutrition support dietitian ideal frequency indicated for the tasks "determines macronutrient composition of parenteral nutrition" and "performs physical examinations related to nutritional status, fluid status, and gastrointestinal function" was significantly greater (P < .001, P < .05), respectively) than the ideal frequency indicated by chief clinical dietitians. Of the nutrition support dietitians, 79% agreed and 16% somewhat agreed that experiences beyond those required for becoming a registered dietitian are needed to provide nutrition support dietitians with specialized clinical skills. APPLICATIONS/CONCLUSIONS: Nutrition support dietitians desire increased responsibility for delivering nutrition support to their patients and this desire is largely supported by chief clinical dietitians. Nutrition support dietitians appear to have a strong interest in postregistration qualifying experiences that would provide a foundation for expanding their roles. According to the results of this study, programs designed to provide practical, clinical experience in nutrition support are needed.

Attitude of Health Personnel↗
PubMed1997

Banana flakes control diarrhea in enterally fed patients.

Diarrhea occurs frequently in the critically ill tube-fed population and may result from a multitude of causes. Despite the availability of antidiarrheal medications, diarrhea associated with enteral feedings remains a problem for clinicians and for the patients affected by it. We tested the hypothesis that administration of banana flakes would control diarrhea in critically ill patients receiving enteral feedings. Thirty-one patients with diarrhea and receiving enteral feedings were randomized to receive either banana flakes or medical treatment for diarrhea. Medical treatments included the use of pharmacological agents according to the discretion of the patient's physician or reducing feeding rates. Both banana flakes and medical treatments reduced the severity of diarrhea in critically ill tube-fed patients. Over the course of treatment, mean diarrhea scores were 21.64 +/- 7.81 for the banana flake group and 25.41 +/- 9.76 for the medical group. These differences were not statistically significant. Both groups achieved similar levels of nutrition support. The banana flake group had less diarrhea clinically, with 57% of the subjects diarrhea free on their last study day as opposed to 24% of the medically treated subjects. This occurred despite a threefold increase in the number of patients testing positive for Clostridium difficile toxin in the banana flake group. We conclude that banana flakes can be used as a safe, cost-effective treatment for diarrhea in critically ill tube-fed patients. Banana flakes can be given concurrently with a workup for C. difficile colitis, thereby expediting treatment of diarrhea.

Adult↗
PubMed1994

Physicians' implementation of dietitians' recommendations: a study of the effectiveness of dietitians.

OBJECTIVE: To determine how often dietitians' recommendations were implemented by physicians and to identify workplace and demographic factors that correlated with successful implementation of recommendations. DESIGN: A cohort of hospitals was surveyed by mail. Dietitians recorded recommendations written in five consecutive medical record entries and sent them to the chief clinical dietitian. Seventy-two hours later, physicians' order sheets were reviewed to assess implementation. Dietitians completed demographic questionnaires. SUBJECTS: Forty-four general hospitals in Philadelphia and the surrounding area were surveyed. To ensure similar standards of nutrition care, only hospitals approved by the Joint Commission on Accreditation of Healthcare Organizations were selected. STATISTICAL ANALYSIS PERFORMED: chi 2, Fisher's exact test, and the Kruskall-Wallis test were used to correlate demographic variables with implementation rate. MAIN OUTCOME MEASURE: Implementation of the dietitians' recommendations by physicians' orders. RESULTS: Responses were obtained from 35 of the 44 hospitals and 98 (70%) of the clinical dietitians. Of the 865 recommendations, 42% were implemented. Significantly higher implementation rates were noted for recommendations solicited by (50%) or discussed with the physician (65%). Dietitians were more successful in teaching hospitals and when they reported to a hospital-operated foodservice rather than a contract foodservice. Success correlated with a lower workload when measured by the ratio of admissions to staff but not when measured by the ratio of beds to staff. CONCLUSIONS: Dietitians could have a greater effect on nutrition care by discussing recommendations with physicians. Further research is needed about staffing formulas and methods to improve the effectiveness of dietitians.

Adult↗
PubMed1991

Collecting data for clinical indicators.

The Joint Commission for Accreditation of Healthcare Organizations is currently testing clinical indicators that will become an important part of hospital quality assurance programs. Implementation of clinical indicators may necessitate more extensive data collection than is now being done. This article reviews important considerations in the development of a data collection system that facilitates the evaluation of indicators of clinical performance. The evolution of the system currently used by the Nutritional Support Service at Pennsylvania Hospital is provided.

Data Collection↗
PubMed1990

A survey of the role of the dietitian in preparing patients for home enteral feeding.

Teaching home enteral feeding is a complex process involving many activities not traditionally performed by dietitians. This survey was undertaken to investigate (a) tasks performed by the dietitian in preparing patients to receive home enteral feeding, (b) the effect of various demographic factors on the dietitian's role, (c) the amount of dietitian time spent preparing a patient for discharge on home enteral feeding, and (d) the types of home enteral feedings currently in use. A questionnaire was tested for reliability and validity, then mailed to 1,168 nutrition support dietitians. Results of the survey indicated that, more often than nurses or physicians, dietitians were responsible for calculating nutrient and fluid needs, selecting formula, determining the home feeding schedule, teaching the patient to prepare blenderized formulas, and teaching the patient to recognize formula intolerance. Dietitians were less often responsible than nurses for psychomotor skills such as teaching the patient to administer the formula, operate the pump, and flush the feeding tube. Dietitians seemed to have a larger role in hospitals with more than 499 beds, in teaching hospitals, and in hospitals with a nutrition support team. Dietitians reported a smaller role when they reported to a contract foodservice company and when their job duties were divided so that more time was spent in clinical dietetics than in nutrition support. However, dietitians in all demographic groups performed all tasks. The average amount of dietitian time spent preparing patients for discharge on home enteral feeding was 168 minutes (2.8 hours) per patient. More patients received gastric feedings (76%) than intestinal feedings (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1986

Specialized formulas for enteral nutrition support.

Enteral or tube feeding is the standard nutritional support modality for patients with a functioning gastrointestinal tract. Expanding knowledge of the role of nutrients in disease has prompted the development of specialized nutrients for patients with specific diseases. Selection of the appropriate formula is critical in maximizing the response to nutrition therapy. Knowledge of related research and the underlying disease process are factors in the selection of appropriate formulas for specialized enteral nutrition support. Careful monitoring of the nutritional and metabolic processes associated with specific diseases is the key to the successful use of the formulas.

Acute Kidney Injury↗