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Dietetic audit--a giant step for nutritional care. The approach at Brooke Army Medical Center.

Issues which must be addressed by clinical dietitians as participants in their hospitals' quality assessment programs (audits) are defined. Solutions and approaches used at various phases of the audit processes by the clinical dietitians at Brooke Army Medical Center are described. Outcome and process criteria for nutritional care of the patients with maturity onset diabetes mellitus are presented, along with samples of the clinical dietitian's documentation in the patient's record. The impact of "audits" on the quality of nutritional care is exemplified by results of a series of audit studies on diabetes mellitus conducted over the past three years. Other benefits which have accrued from participation in the hospital's audit programs are enumerated.

Clinical Competence↗

[For what we need clinical nutrition].

Clinical nutrition covers a wide range of specialties of medicine. There is a need for better nutritional support in prevention of chronic diseases, investigations to assess malnutrition, dietetics including artificial nutrition and rehabilitation as well as supportive care for the severely and terminally ill patients. Clinical nutrition follows the principles of evidence-based medicine. In future the training of doctors in human nutrition has to be further improved. Since nothing works well in isolation an integration of clinical nutrition into gastroenterology is recommended.

Education, Medical↗

[Ancient dietetics - lifestyle and medicine].

The wide reaching meaning of eating and drinking is already recognized in antiquity. The declared aim of antique dietetics is the upbringing to a healthy lifestyle. Fundamental considerations of dietetic, theoretically organized ideas can be traced back to the Presocratics, who, for the first time in cultural history, let themselves be guided by direct observations from nature. Working from the meaning of dietetics as pure nutritional teaching, one can see in the Corpus Hippocraticum a significant, systematic attempt to put forth dietetics as a concept of lifestyle. Here a central aspect is that of equilibrium, as it is expressed in the rule of the four humours. Dietetics continually become a connecting link between Natural Philosophy and Anthropology and a lifestyle orientated to nature. Finally, Galen introduces a further systematization of the already existing and the increasingly modified. Nutrition and health are brought into association and the theoretical presupposed practically overturned. In late Antiquity dietetical outlooks continue to be discussed, which were transferred to the Middle Ages and still show practical relevance.

Dietetics↗

Soils and health.

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Dietetics↗

Clinical and laboratory assessment of nutrition status in dental practice.

There is a dynamic, two-way relationship between nutrition status and local oral health/systemic disease. Functional alterations in the oral cavity can impact the ability to ingest and swallow a typical diet. Nutrition status may influence disease progression and recovery from infection and surgery. Malnutrition and individual nutrient deficiencies can affect tissue integrity and muscle function. The benefits of a nutrition screening program in dental practice are many. First and foremost, it provides another critical component of the comprehensive health evaluation of the patient. Other positive outcomes are numerous and include improved oral and overall health, early detection of diet and nutrition problems, improved probability of successful treatment, improved wound healing and tissue resistance, and increased communication with patients. The extent to which practitioners provide oral health-related diet information in their practices or refer patients to a registered dietitian for medical nutrition therapy varies. Registered dietitians provide comprehensive nutrition care as a component of medical nutrition therapy. The American Dietetic Association (www.eatright.org) provides a nationwide nutrition network available at their Web site to locate a registered dietitian in a particular geographic area. As the primary care provider for the oral cavity (the entry point to the gastrointestinal track), the dental professional should screen patients to determine nutrition risk, integrate the finding into the patient s treatment plan, offer appropriate guidance to manage nutrition issues related to dental sequellae, and provide the necessary referrals.

Dentistry↗

Integrating issues of sustainably produced foods into nutrition practice: a survey of Minnesota Dietetic Association members.

A survey was mailed to a representative, randomly selected sample of Minnesota Dietetic Association members (n=300) to evaluate attitudes and intentions regarding the integration of issues pertaining to sustainably produced foods into professional practice. The United States Department of Agriculture describes sustainable agriculture as including goals of farm profitability, environmental stewardship, and improved rural quality of life. Data analysis included descriptive statistics, independent t tests, one-way ANOVA, correlations, and multiple regression analyses (P< or =.05). Forty-three percent had heard of sustainable agriculture, 13% had integrated issues of sustainably produced foods into their practice, and 20% stated that it was likely that they would incorporate these issues within the next six months. Perceived behavioral control, subjective norm, and rated importance of knowing about agricultural practices independently predicted intention. Dietitians surveyed were interested in learning more, but most were not integrating these issues into practice because of perceived barriers, including a lack of knowledge about this topic.

Adult↗