R.M. Bush

Nutrition Knowledge and Intake of Selected Nutrients in Pregnant Women with and Without AIDS/HIV

Abstract Subjects were a convenience sample of pregnant women attending OB/GYN and OB/GYN Immunology outpatient clinics in a major metropolitan area. After providing consent, 16 HIV+ and 21 HIV− pregnant women completed a nutrition knowledge and food safety questionnaire specific for pregnant HIV+ women. The subjects were also interviewed to obtain demographics and a 24-hr food recall. The average age of the subjects was 23 years. No significant differences were found between the HIV+ and HIV− subjects for age, height, pre-pregnancy weight, or current weight No significant difference was found in knowledge scores of the two groups (p=0.302). Mean knowledge scores of the HIV+ and HIV− subjects were 67.3% ± 15.4 and 62.5% ± 12.5, respectively. Higher intakes of calories, protein, and folate (p=0.017, p=0.003, and p=0.006, respectively) were found in the HTV+ group. Additionally, a higher proportion of the HIV+ group met the recommended level or RDA for specific nutrients. Registered Dietitians were reported as the source of nutrition information by only 6.3% of the HIV+ subjects in comparison to 19.1% of the HIV− subjects. Only 25% of the HIV+ subjects reported that issues of food safety had been discussed with them. Despite some differences in intake between HTV+ and HIV− pregnant women, the results of this study demonstrate a continuing need for education on nutrition and food safety issues in this population. Because the sample size of this study was small, more studies are needed to corroborate the results.

The Relationship between the American Dietetic Association's Position on the Dietitian's Role in Feeding Terminally Ill Patients and Dietitians’ Actual Attitudes and Practices

Abstract LEARNING OUTCOME: To identify attitudes and practices of dietitians related to the ethics of feeding terminally ill patients The American Dietetic Associations (ADAs) position paper on feeding terminally ill patients, which was published in 1987 and reviewed and updated in 1992, advocates that the dietitian take an active role in developing criteria for feeding the terminally ill adult within the practice setting, participate in making recommendations for each case, and be a part of the hospital ethics committee. According to the position paper, dietitians need to be aware of personal factors that could interfere with the execution of their responsibilities in dealing with the terminally ill. No research was found in the literature indicating whether or not dietitians are actually able to follow the ADA guidelines. In order to determine how dietitians are using these guidelines, a survey was sent to 105 hospital-based dietitians, who had or have had experience with critically ill patients, to determine their attitudes and practices in relation to ethical issues in feeding the terminally ill; 71 surveys were returned. The surveys indicated the majority of dietitians were not following the guidelines at that time. Less than one-third of the facilities had written guidelines for feeding the terminally ill or for withdrawing nutritional support. The medical climate was not felt to be accepting of the dietitian participating in the making of decisions regarding nutrition support for the terminally ill. A majority of the dietitians (80%) felt that more education and training were needed in the area of ethics and feeding the terminally ill patient. This survey demonstrates the need for more education and training of dietitians regarding feeding the terminally ill. Dietitians responses and comments indicated a positive interest in this area of patient care.

Practices of Pediatric Hospitals Regarding Drug-Nutrient Interaction Counseling Programs

Abstract In recent years, the Joint Commission for the Accreditation of Healthcare Organizations has focused on assessment of needs, both educational and medical, with recent emphasis on drug-nutrient interactions. Registered Dietitians (RDs) were surveyed at forty-five freestanding, acute care pediatric hospitals to determine the health professional who performs inpatient and outpatient counseling, how patients are identified, the drugs chosen, and when the counseling is provided. Seventy-eight percent (n = 35) of surveys were returned. Nurses (38.2%) were identified as the primary educator for inpatient counseling followed by RDs (26.0%). Pharmacists (32.3%) performed most outpatient counselings. The most common means of identification for inpatient counseling is by the RD scanning charts (n = 19), followed by the Pharmacist noting the interaction (n = 16). Outpatients were screened by Pharmacists (n = 18) followed by the RD (n = 10). The top five drug categories targeted for counseling include: anticonvulsants (n = 35), antibiotics (n = 33), diuretics (n = 26), bronchodilators (n = 19), and anticoagulants (n = 16), which accounted for 54% of the total drugs cited. In 51.4% (n = 18) of the 35 facilities, counseling is provided both at the time of discharge and during hospitalization, and only at the time of discharge in 31.4% (n = 11) hospitals. Reports cited in the literature have almost exclusively studied adults concerning drug-nutrient interactions. This survey provides new insight into the mechanisms employed for education and the targeted drugs most significant for this specialized population.