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Health mobilization and the dietitian.
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Nutrition education: a survey of practices and perceptions in undergraduate dietetics education.
Electronic mail messages linked to an online survey were sent to 281 directors of didactic and coordinated programs in dietetics to investigate coverage of nutrition education in undergraduate curriculua, perceived importance of topics, and perceived trends. Descriptive statistics and content analysis were performed on responses from 117 programs. Programs addressed nutrition education through a variety of methods and materials. Fifty-three percent (n=62) offered a course dedicated to nutrition education. The most common teaching methods were didactic (88%) and experiential learning (87%). Most of the topics investigated, including those addressed by the Commission on Accreditation for Dietetics Education Accreditation Manual, were viewed as important, very important, or essential. Perceived trends included increased use of technology, theories/models, client-centered education, cultural awareness, and behavior change. Eighty-eight percent of respondents indicated satisfaction with nutrition education curriculum strategies. Dissatisfaction was associated with inadequate time and resources, need for course improvement, and lack of control over experiences. Results may aid in curriculum development.
[Balanced nutrition concept and its application in dietetics].
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Leadership in clinical dietetics: meeting the challenge to roles in nutritional support.
The success of efforts to improve nutrition training of other health professionals poses a threat to the position of clinical dietitians as authorities in nutrition. In situations in which no dietitians are present or dietitians' skills are not recognized, pharmacists and nurses are especially likely to take over nutritional support roles traditionally assigned to the clinical dietitian. At the University of California, San Francisco, where dietitians are included in nutrition education and patient care programs and where understanding of the role of the dietitian is a stated educational goal, a preliminary survey suggests that conflicts occur in roles that are shared by members of nutritional support teams. Factors contributing to role conflicts include not only inadequate education of other health professionals but also problems of job expectations, education, training, and self-image among dietitians. Improved training in clinical nutrition, acquisition of better team and patient care skills, documentation of the effectiveness of dietetic services, and efforts to improve status and visibility would help alleviate role conflicts and ensure clinical dietitians a more rewarding place in the health care system.
A new strategy for cost-effective care: clinical dietetic staffing by diagnosis.
Conventional methods for measuring and justifying appropriate clinical dietetic staffing are enhanced by linking actual patient needs for nutrition care to clinical dietetic staffing levels. Nutrition care is categorized into basic and in-depth activities. Basic care is correlated to active diet orders and in-depth care to patient diagnoses. Data collection, including time studies, is necessary to extrapolate individual patient requirements for basic and in-depth nutrition care to total requirements characteristic of a given clinical setting. Applying a mathematical formula to data collected, final calculation of total labor requirements is achieved. This correlation of staffing to patient requirements for nutrition care has been responded to favorably by hospital administration. Further challenges lie in dietetic protocol development, which should contribute to consistently high-quality, cost-effective nutrition care.
American Dietetic Association: standards of practice in nutrition care and updated standards of professional performance.
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Taking the lead on a national nutrition policy.
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[A half-century of nutrition therapy].
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[Dietitians are the only group specially trained for nutrition therapy].
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[The pluralism of scientific concepts and the development of the science of nutrition].
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Contribution of home economics research to the improvement of human nutrition.
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Position of the American Dietetic Association and Dietitians of Canada: nutrition intervention in the care of persons with human immunodeficiency virus infection.
Infection with the human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) have had a significant impact on domestic and global health, social, political, and economic outcomes. Prevention and treatment efforts to control HIV infection are more demanding than in previous decades. Achieving food and nutrition security, and managing nutrition-related complications of HIV infection and the multiple aspects of disease initiated by or surrounding HIV infection, referred to as HIV disease, remain challenges for patients and for those involved with HIV/AIDS prevention, care, and treatment efforts. Confounding clinical issues include medication interactions, coinfection with other infections and diseases, wasting, lipodystrophy, and others. Dietetics professionals, other health care professionals, and people infected with HIV will need to understand and address multiple complex aspects of HIV infection and treatment to improve survival, body functions, and overall quality of life. Individualized nutrition care plans will be an essential feature of the medical management of persons with HIV infection and AIDS.
The role of the nutritional support dietitian in Europe.
UNLABELLED: The European Community now supports the potential for professionals to practice in any of the member states subject to recognized local standards of education and practice being achieved. However, there is no agreed role for the nutritional support dietitian. This leads to an inconsistent and, sometimes, fragmented approach to the nutritional management of patients throughout Europe. There is a need to develop a common dietetic approach to nutritional support in order to raise awareness and rationalize standards. This will help to optimize care to individual patients by fostering good practice, developing effective communication and encouraging research. BACKGROUND: The role of the clinical dietitian varies widely throughout Europe - it tends to be more highly developed in some countries than in others, which is a cause for concern among dietitians in ESPEN. This appears to be caused by several factors including education, clinical awareness of the benefits of dietetic support and access to adequate financial resources. The intention of this paper is to focus on the key aspects of the role of the dietitian working in nutritional support. The educational requirements of such a dietitian are outlined and these could be used as a preliminary guide for institutions responsible for delivering undergraduate dietetic programmes. The overall intention is to identify minimum educational standards for practice in this field throughout Europe. However, these should be viewed as a baseline from which to proceed. They should also be perceived as a quality standard for facilitating professional development, sharing clinical practice and enhancing patient outcomes. This paper does not address issues of resource allocation. RECOMMENDATIONS: a) There should be agreement about the key functions of the dietitian working in nutritional support; b) There should be a common standard at first degree level for all dietitians; c) There should be an identified programme of post-graduate study (both clinical and academic) leading to specialization in nutritional support; d) There should be an innovative approach to providing clinical support for emerging specialists; e) ESPEN should investigate the potential for developing an accredited and integrated European dietetic standard in nutritional support.
Derivation of daily values used for nutrition labeling.
Daily Values (DVs) are the daily dietary intake standards used for nutrition labeling. Information on the derivation of DVs is important for dietetics professionals and nutrition educators who use DVs to educate and instruct patients and students about diet planning and evaluation and about adherence to modified diets. The first daily intake standards for nutrition labeling were established in 1973 and were referred to as the US Recommended Daily Allowances (US RDAs). They were based on the 1968 Recommended Dietary Allowances (RDAs) developed by the National Academy of Sciences. These intake standards were mandatory for 8 and optional for 12 food components on nutrition labels. Regulations revising the daily intake standards for nutrition labeling were published in 1993. The new standards included Reference Daily Intakes (RDIs) for 19 food components and Daily Reference Values (DRVs) for 8 food components. The RDIs were based on the 1973 US RDAs, and the DRVs were based on consensus recommendations. On the nutrition label, the RDIs and DRVs are referred to as DVs. Percent DVs are mandatory on nutrition labels for 10 food components and optional for 16 food components. In 1995, DVs were established by regulation for 6 additional food components; these DVs are optional for nutrition labels. The DVs established in 1995 were based on information from the 1980 and 1989 revisions of the RDAs and Estimated Safe and Adequate Daily Dietary Intakes. Currently, percent DVs are mandatory on nutrition labels for 10 food components and optional for 22. Optional percent DVs become mandatory if claims are made about the food components or if the food components are added to the food through fortification or as food additives.
Position of the American Dietetic Association and Dietitians of Canada: nutrition intervention in the care of persons with human immunodeficiency virus infection.
Human immunodeficiency virus (HIV) targets the immune system, making an infected person susceptible to infection and neoplasm because of an impaired ability to mount an adequate immune response. Malnutrition and its complications can further render an HIV-infected person susceptible to opportunistic infection and reduced effectiveness and tolerance to medications and other therapies. Though effective antiretroviral treatments have dramatically reduced death rates in the United States and Canada, HIV-infected people face a lifetime of vigilant polypharmacy to control HIV and associated complications. Malnutrition, various forms of tissue wasting, fat accumulation, increased lipid levels, and risk of additional chronic disease have become central issues in health care plans. It is the position of the American Dietetic Association and Dietitians of Canada that efforts to optimize nutritional status, including medical nutrition therapy and nutrition-related education, should be components of the total health care provided to people infected with human immunodeficiency virus HIV.
Origin and organization of the Irish National Nutrition Survey.
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