Searching the evidence: the clinically-effective nutritionist

As a clinically-effective nutritionist faced with needing to find the answer to a clinical question quickly it is necessary to search the best evidence efficiently. The requirements are to: (1) avoid having lots of papers to read; (2) be able to access this information at one's place of work; (3) restrict reading to trials and systematic reviews of trials. If a decision has to be made while on the ward, the best resource is probably an easy-to-use book, Clinical Evidence. This resource is also available on-line, but there may not be access to the Internet on the ward. If a little more time is available, and access to the Internet, the following plan is suggested: (1) work out what the question is and highlight the search terms; (2) using the best search engine available, search MEDLiNE from 1990 for titles and abstracts of papers containing the search terms, this is the search strategy (limit the search by publication type by requesting randomised controlled trials only, English language only and human only); (3) if more or less than approximately ten hits are obtained, alter the limits of the search (not the search strategy); (4) read the abstract, or full paper where available, of the relevant hits and appraise this evidence.     

Management of self-starvation: a greater role for the nutritionist?

There are no reports of controlled trials of management practices in anorexia nervosa, and a paucity of follow-up data. We investigated the nutritional requirements of four adolescent females with the condition, and describe a management approach based on nutritional principles. The aim was to reverse the initial state of catabolism by enteral nutrition prior to any negotiation regarding oral energy consumption.
The median age of presentation was 14.15 years (range 14–16.1 years). All girls had abnormal perceptions relating to food and phenotype. The median weight loss in the preceding 6 months was 27% (range 21–33%). At presentation the median energy intake was 2710 kJ per day (range 2083–4166 kJ) and represented a median of 26% of that expected. The mean initial energy requirements to reverse the state of severe malnutrition were 14 634 kJ per day. The median time to regain 50% of lost weight was 44 days.
Energy requirements in this disease have been underestimated by both patients and caregivers. Supplementing oral intake with energy-dense defined formulae delivered by nasogastric tube is a safe and rapid method of achieving nutritional rehabilitation in the early stages of self-starvation.     

Discourse and practice of care to newborns at risk: reflecting about humanized care

This study identifies nurses' opinions on humanized care for newborn at risk and their families, using Paterson and Zderad's theory (1976) as a theoretical-methodological reference framework. It was carried out at the Neonatal Intensive Care Unit of a maternity in Fortaleza-CE, between April and July 2003. Data were collected through interviews with 6 nurses. They approached the following themes: humanization, sensitiveness, conscience and care. There is a need to unite discourse with practice in humanized care for newborns at risk.     

Hospital care for the terminally ill: a model program

While community hospitals increasingly are becoming community health care centers, evidence suggests a great need for most of these institutions to improve their care of the terminally ill. Based on a study of existing care programs and of thanatology literature, the authors have developed a model hospital program for dying patients and their families that uses a team approach to integrate resources for their care.     

A computerized diet analysis system for the research nutritionist

A computerized diet analysis system can assist in the many dietary computations performed daily by the research nutritionist. When selecting a computerized diet analysis system, the research nutritionist must consider present and future needs and select a system that is accurate, efficient, and cost-effective. The purpose of this article is to review the computer needs of the research nutritionist, identify areas to be considered when selecting a diet analysis system, and describe a system that functions easily in research or clinical settings. The diet analysis system described here is interactive and easy to use and provides flexible programming to accommodate changing research or clinical needs. The nutrient data base is accurate, verified, and periodically updated by the company that provides the system. Data entry is easy, and new foods or recipes can readily be added to the nutrient data base. The system's programs and special features provide efficient, accurate methods for creating and analyzing complex research diets, analyzing nutrient intake, and reporting nutrient data.     

Hospital nurses' perception of public health

The objective of this work was to study hospital nurses' perceptions of public health based on a pedagogical exercise. A qualitative study, lead by students of a training institute for nursing care (IFSI), was conducted using semi-directed interviews of hospital nurses from different departments of a provincial hospital. The main results show that for one-third of the nurses interviewed, the hospital is not a setting for public health practice. In terms of their definition of public health, it is closely linked to the concept of prevention, with primarily individual approaches. This definition is very close to the public health activities that they conduct at the hospital and which are centred on information and disease prevention, on education related to pathologies and the relationship between the provision of care and listening to the patients and their families. Few nurses place their public health activities within the scope of the areas of hospital cleanliness, the welcoming of the patients, the organisation of services, and the improvement of the quality of care. The potential tracks which have emerged from this work lead to the need for the strengthening of training in patient education, in the hospital's work networking with external partners, and in better development of public health activities undertaken in the hospital setting.     

Frequent attenders in out-of-hours general practice care: attendance prognosis.

OBJECTIVE: We aimed to describe the use of out-of-hours service and analyse attendance prognosis for frequent attenders and other groups of attenders, and to present a concept describing frequent attendance over time. METHODS: All adult attenders in 1990 were included in a 4-year follow-up study. Frequent attenders (FAs) were defined as those 10% among the attenders who most frequently used the out-of-hours service during a calendar year (12 months). This gave an intersection point of four or more contacts for frequent attenders. Three more groups were defined according to whether they had one, two or three contacts per year. The setting was out-of-hours general practice in Aarhus County, Denmark. Data were collected from the database of the Public Health Insurance, Aarhus County. The county had approximately 600,000 inhabitants, of whom 465,000 were aged 18 years and over. The subjects were 101,321 individuals aged 18 years and over who contacted the out-of-hours service in 1990. Outcome measures were attendance per year, age and sex. RESULTS: FAs made 42% of the out-of-hours contacts in 1990, and 33% of those who were FAs in 1990 were also FAs in 1991. Among the 1990 FAs, 67% contacted the out-of-hours service at least once in 1991, 25% contacted the service at least once in each of the following 4 years and 7% remained FAs in the following 4 years. The probability of being an FA rose with the duration of previous frequent attendance. Age above 50 years significantly predicted future status as an FA. Females made up two-thirds of FAs, but sex did not predict future frequent attendance. CONCLUSION: Frequent attendance could be regarded as a short-lived phenomenon. On the other hand, FAs were the most stable attenders of all groups of attenders over the years. Older FAs had the highest probability of remaining FAs.     

Perception of humanized care from the perspective of diabetic human being

The present work aimed at identifying the understanding of the diabetic human being to about the care received by the nursing team and the understanding about delivered care related to the treatment. Methodology was based on qualitative approach based on the theoretical referencial of Trentini and Paim--Care Convergent Research. The results directed to three categories: The care as expression of affection; the care delivered by the nursing team for the diabetic client; the care idealized in the perspective of the diabetic client. This study launches a possibility of reflection in order to motivate new positions as well as new horizons to propitiate a more collective and human rethinking.     

Social class,ethnicity and attendance for antenatal care in the United Kingdom: a systematic review

BACKGROUND: Evidence from outside the United Kingdom points to several socio-demographic factors associated with late initiation of antenatal care or fewer antenatal visits, but it is not clear how generalizable these studies are to the UK context. This systematic review addresses the question of whether there are social or ethnic inequalities in attendance for antenatal care in the United Kingdom. METHODS: We identified and reviewed UK studies assessing attendance for antenatal care according to any measure of social class, social deprivation or ethnicity. A wide range of electronic databases was searched for published and unpublished studies. Further studies were identified from reference lists, citation searches and key organizations. RESULTS: From over 1300 identified papers, 20 were potentially relevant. Nine were included in the review. Most studies were of poor quality, with only one study controlling for the effect of potential confounders such as age, parity and clinical risk factors. All but one were based on data collected around 20 years ago. Three of the five studies looking at antenatal attendance and social class found that women from manual classes were more likely to book late for antenatal care and/or make fewer antenatal visits than other women. All four studies reporting on antenatal attendance and ethnicity found that women of Asian origin were more likely to book late for antenatal care than white British women. CONCLUSIONS: There is little good quality evidence on social and ethnic inequalities in attendance for antenatal care in the United Kingdom. Recommendations for further research are suggested.     

Culturally acceptable health care services for Saudi's elderly population: the decision-maker's perception

This article reports on a study carried out in 1993 to elicit the opinions of decision makers (medical and non-medical) as to the types of facilities, locations and culturally acceptable levels of health care appropriate for the elderly in Saudi Arabia. In addition, the study sought to find out the procedures and likely constraints in the development of future health care services for the elderly. An opinion survey was carried out on a randomly selected sample of decision makers, drawn from: hospitals of 100-bed capacity or more; and, from directorates of education, agriculture, police, municipalities, commerce, transport and media, in each of the regions of Saudi Arabia. A predesigned Arabic questionnaire was completed by the respondents during February-April, 1993. Of the 244 respondents, the most important categories of elderly to be cared for were considered to be those with handicaps, the chronically ill, and those without family support. The non-medical decision makers gave higher scores to these alternatives than did the medical decision makers (P < 0.05). Use of the family home for elderly health care was rated as the most appropriate, followed by medical rehabilitation centres, and only then by hospitals. Non-medical respondents gave more emphasis on rehabilitation centres (P < 0.02). Medical respondents thought that primary care doctors (87.2%), physiotherapists (87.2%) and general nurses (78.2%) can adequately fulfil the needs of most elderly patients. In contrast, non-medical respondents demanded the presence of specialist doctors (72.3%), specialist nurses (78.9%), laboratory and X-ray facilities to run such services (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)