Nedra Christensen

Warfarin Knowledge in Patients with Atrial Fibrillation: Implications for Safety, Efficacy, and Education Strategies

Background: Multiple factors influence warfarin metabolism and can significantly affect the risk of adverse events. The extent to which patients understand the modifiable factors that impact on warfarin safety and efficacy is unclear. Methods: A 52-item questionnaire related to knowledge of warfarin was administered to patients with atrial fibrillation in a face-to-face interview with a dietitian. Results were compiled based on five categories: general warfarin knowledge, compliance, drug interactions, herbal or vitamin interactions, and diet. Results: 100 patients were surveyed. Stroke risk factors included hypertension (57%), heart failure (36%), age >75 years (33%), diabetes (22%), and prior stroke/transient ischemic attack (29%). The majority were either high-school (49%) or college graduates (27%). Ten (10%) had a stroke while on warfarin, 11 (11%) had a blood transfusion, and 26 (26%) had at least one fall. The percentages correct for questionnaire items in the five categories were as follows: general knowledge (62%), compliance (71%), drug interactions (17%), herbal or vitamin interactions (7%), and diet (23%). Neither education level nor duration of therapy correlated with warfarin knowledge. Patients at highest risk of stroke had very low knowledge scores in general. Discussion: Patients on warfarin have a poor general understanding of the medication, particularly those at highest risk of stroke.

The Effect of Computerized Dietary Analysis Nutrition Education on Nutrition Knowledge, Nutrition Status, Dietary Compliance, and Quality of Life of Hemodialysis Patients

■ Objective: To assess the effect of nutrition education, using computerized dietary analysis, on nutrition knowledge, nutrition status, dietary compliance, and quality of life in hemodialysis patients. ■ Design: A 6-month nonrandomized control study including 3 months of prestudy data. ■ Setting: A free-standing dialysis center that treated approximately 50 hemodialysis patients. ■ Patients: Twenty chronic hemodialysis patients (treatment: n=12, control: n=8) who voluntarily agreed to participate. ■ Interventions: All study participants completed prestudy and poststudy quality-of-life assessments, a depression inventory, and a nutrition knowledge assessment. Patients in the treatment group completed monthly 3-day food records, which were analyzed by computer nutrient analysis software. Results were discussed with the patients during one-on-one education sessions. Control patients completed prestudy and poststudy 3-day food records. ■ Main outcome measures: Change in prestudy and poststudy assessment scores, nutritionrelated laboratory data, anthropometric data, and dietary data. ■ Results: The treatment groups nutrition knowledge test scores significantly improved. Nutrient intakes showed no significant changes except for calorie intake, which decreased in the treatment group. Serum albumin and total protein increased in both groups, and the protein catabolic rate (PCR) of the treatment group increased significantly. The treatment group showed improvement in the alertness behavior area of the Sickness Impact Profile (SIP), and the control group declined in the recreation and pastimes area of the SIP. ■ Conclusions: Computerized dietary analysis is an effective instruction tool, is helpful in improving dietary protein intake as measured by PCR, and may contribute to improved quality of life of hemodialysis patients.

Developing an online certification program for nutrition education assistants.

OBJECTIVE To develop an online certification program for nutrition education paraprofessionals to increase knowledge and confidence and to overcome training barriers of programming time and travel expenses. DESIGN An online interactive certification course based on Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program core competencies was delivered to employees of both programs. Traditional vs online training was compared. Course content validity was determined through expert review by registered dietitians. Parameters studied included increase of nutrition knowledge and teaching technique/ability, educator satisfaction, and programming costs related to training. SETTING Utah State University Extension. PARTICIPANTS Twenty-two Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program educators in Utah. MAIN OUTCOME MEASURES Knowledge and skills were measured using pre/posttest statistics. Participant satisfaction was measured with a survey. ANALYSIS Paired t test; satisfaction survey. RESULTS The change in paraprofessional knowledge score was statistically significant (P < .001). Forty percent of paraprofessionals strongly agreed and 60% agreed they were better prepared as nutrition educators because of the training. An estimated

Nutrition knowledge and confidence levels of parents of children with cystic fibrosis.

16,000 was saved by providing the training online as compared to a face-to-face training. CONCLUSIONS AND IMPLICATIONS This interactive online program is a cost-effective way to increase paraprofessional knowledge and job satisfaction.

Virginia Agricultural Safety and Health Survey

Optimal growth and nutrition status predict better lung function and longevity for children with cystic fibrosis (CF). Daily nutrition therapy for children with CF requires adequate food resources,...

Depression as a Risk Factor for Agricultural Injuries

Injuries and occupational illnesses are far more common among farmers and farm workers than in other occupations. The need to reduce the risk associated with agricultural operations is obvious. Past studies focusing on acute or traumatic injuries associated with agricultural work have provided valuable information to planners and educators. The primary objective of this study was to determine the effect of exposure to agricultural hazards on traumatic injuries, chronic illness and the general health outcomes of farmers in Virginia. A sample size of 1650 was selected to reduce potential sampling errors, and over 300 farmers returned a completed survey. Results of the analysis showed that 1.5% of the respondents had at least one injury requiring medical attention or missing work for a half day or longer during the 12 months preceding the survey. Falls, heavy lifting, farm machinery repairs, and power tools were found to be the major causes of injuries. Rates of chronic health problems among the respondents were comparable with non-agricultural populations and did not appear to be influenced by exposure to common agricultural hazards.

Effectiveness of Medical Nutrition Therapy and Self Management Training in Lowering Hemoglobin Ale Values

The agricultural industry has historically had one of the highest injury and mortality rates, and they have been on the rise during the past decade. Appropriate educational programs are essential to reverse this trend. To help extension educators and health care professionals with the development of such programs, a study dealing with health and safety concerns of farmers and farm workers in Virginia was initiated with multiple objectives. One aspect of this broad study, the effect of depression on agricultural injury rate, is discussed in this paper.

Attitudes toward percutaneous endoscopic gastrostomy placement in cystic fibrosis patients.

Abstract Objectives: The main objective of this study was to determine the effectiveness of medical nutrition therapy (MNT) and self management training (SMT) provided specifically by a R.D. in lowering hemoglobin Ale (HbAlc) values. Additionally, correlations were calculated between patients* perceived diabetes control versus actual control as assessed by HbAlc. Methods: Subjects consisted of 15 Type I and 87 Type 2 diabetics diagnosed for at least six months. Patients who were pregnant or had end-stage renal disease were excluded. Medical records were reviewed before and after nutrition education sessions with the R.D. Data on patient level of understanding, demographics, anthropometries and goals were collected. Results: Mean pre-education HbAlc of 9.32% decreased significantly to 7.74% (p Conclusion: MNT and SMT provided by an R.D. is effective in improving diabetes control in all subjects. Improved control results in decreased complications and thus significant cost savings.