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Issue 170 - 23 Feb 2011

Our sympathy and support go out to the people of Canterbury after the devastating earthquake and ongoing aftershocks

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Articles on Nutrition

1. Seeing food through older eyes: The cultural implications of dealing with nutritional issues in aged and ageing
By Burns, Cate. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p200-201
The author reflects on the significance of a cultural perspective in managing nutritional issues in the aged and ageing. In food, he defines cultural as the common knowledge, beliefs and customs of ethnic groups in food and eating. He mentions cultural values are established as primary part of social action in individual's life. He concludes food habit of older people would be the outcome of cultural differences not only in terms of ethnic origin, but also on socioeconomic position..

2. Treating malnutrition in hospitals: Dietitians in the driving seat?
By Walton, Karen. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p202-205
The article provides an overview on the malnutrition practice in different Australian hospitals in Australia. It views that for various reasons, malnutrition practice in hospitals nationwide is not positively appreciated, with importance for patient satisfaction and matching dollars value. It recommends the creation of an effective standard to improve the nutritional care services in hospitals. Dietitians are encouraged to adopt the standard in treating malnourished patients nationwide..

3. Malnutrition identification, diagnosis and dietetic referrals: Are we doing a good enough job?
By Gout, Belinda al. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p206-211

Aim: To determine the prevalence and diagnosis, documentation and referral rates for malnutrition among hospitalised patients and to ascertain potential shortfalls in financial reimbursement to a hospital as a result of malnutrition misdiagnosis.
Methods: The Subjective Global Assessment tool was used to assess the nutritional status of 275 randomly selected inpatients on admission over a five-week period across the acute care wards of a metropolitan tertiary teaching hospital. A retrospective audit of malnourished patients' medical histories was performed to assess diagnosis, documentation and dietetic referral rates for malnutrition. Where malnutrition was not included in the coding of an admission, that admission was hypothetically recoded to determine whether it changed the Diagnosis Related Group and subsequently the payment allocated for that admission.
Results: Prevalence of malnutrition was 23%. Malnourished patients had significantly longer lengths of stay by 4.5 days compared with well-nourished patients ( P < 0.001). Only 15% of malnourished patients were correctly identified and documented as such in the medical histories. A dietitian was involved in 45% of malnutrition cases, but only documented 29% of such cases as malnourished. Forty-eight of 53 (91%) audited cases did not have the corresponding malnutrition code included in their Diagnosis Related Group, resulting in a shortfall of AU$27 617 to the hospital in reimbursements, and AU$1 850 540 when extrapolated across the financial year.
Conclusion: Malnutrition is highly prevalent in the acute hospital setting, yet remains poorly identified and formally documented. Many patients are not referred for dietetic intervention, thus compromising their clinical outcomes. Poor documentation of malnutrition can further result in financial shortfalls to the hospital. [ABSTRACT FROM AUTHOR]

4. Patient satisfaction and energy intakes are enhanced by point of service meal provision
By Mahoney, Sarah et al. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p212-220

Aim: This systemic review aimed to investigate the effects of various methods of point of service meal provision on patient satisfaction and energy intakes of hospital patients.
Methods: ‘Medline’ and ‘Wiley Interscience’ online databases (1999–2008) were consulted using search terms such as ‘food service’ and ‘food delivery in hospital’. Cross-referencing was also used to select studies that compared the provision of full diets to hospital patients using two different methods of food service delivery.
Results: Searching yielded 268 studies, of which 18 met the inclusion criteria (hospitals, all ages, oral intake only). Patient satisfaction was measured in 12 studies, while 9 studies measured energy intake, 9 measured food wastage and 4 studies measured costs.
Conclusion: There is evidence to suggest that a more personalised meal service system in hospitals has the ability to improve energy intakes and patient satisfaction. Further research is necessary to evaluate the long-term implications on cost-effectiveness. [ABSTRACT FROM AUTHOR].

5. Economic analysis model for inpatient parenteral nutrition: A pilot study.
By Poole, Rosalind et al. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p221-226
Parenteral nutrition is a high-cost but essential support service in contemporary health care, yet no model exists to determine the total cost. This study aimed to create a cost analysis model identifying both direct and indirect costs of parenteral nutrition inpatient care.
Methods: A health economics analysis model was constructed and used to create an audit tool for measuring parenteral nutrition costs in seven predefined categories. This tool was piloted on a cohort of 21 consecutive patients commencing parenteral nutrition at a large city hospital between March and April 2008. These patients were prospectively audited for a maximum 12 days or until parenteral nutrition cessation (192 patient days). Costs and adherence to evidence-based guidelines were compared across the seven categories and between patient subgroups determined by ward locality upon commencement.
Results: The mean total cost for all parenteral nutrition patients was $1579(NZD)/day, of which non-parenteral hospital costs comprised 85%. For patients treated solely outside the intensive care unit, cost was $1045 per day, of which 24% was directly attributed to provision of parenteral nutrition. Formula accounted for nearly two-thirds (63%) of parenteral nutrition direct costs and 8.5% of that prescribed was wasted. Return to oral or enteral nutrition was achieved in 57% patients within 12 days of commencing parenteral nutrition.
Conclusions: Direct costs involved in providing parenteral nutrition appear to be less than previously reported, and represent a relatively small proportion of the total cost of care. This cost category analysis may have application in measuring and comparing parenteral nutrition service delivery in other institutions. [ABSTRACT FROM AUTHOR].

6. Assessment of typical food portion sizes consumed among Australian adults
By Rangan, Anna al. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p227-233
To document the typical portion sizes of commonly consumed foods as reported by adults in the 1995 National Nutrition Survey, and to compare these data with existing information on serving sizes used in Australia.
Methods: Portion sizes of foods were defined as total amounts of food consumed per eating occasion, using estimated food portion weight data from the 1995 National Nutrition Survey. Age- and sex-specific median (typical) and interquartile ranges were produced for the most commonly consumed foods for Australian adults. These were compared with other data on weighed food records, sample servings as used in the Australian Guide to Healthy Eating and ‘unspecified’ serves as used in nutritional analysis software.
Results: Typical portion sizes for many commonly consumed foods varied significantly by age and sex of the consumer, with larger portion sizes being consumed by men, and by younger adults. Portion size differences between sex were not consistent across food types; therefore, a fixed ratio cannot be applied to all food types. Typical portion sizes estimated from the National Nutrition Survey were similar to median portion sizes obtained from weighed food records for many foods but were not similar to the generic sample servings and ‘unspecified’ serves. Conclusions: The significant age and sex differences in portion sizes consumed indicate the need for age- and sex-specific portion sizes in dietary analysis. Portion size research has particular relevance to the current revision of the dietary guidelines, core food groups and the development of a new food guide in Australia. [ABSTRACT FROM AUTHOR].

7. Increasing the policy focus on nutritional issues for those at home with dementia: What do we need?
By Watkins, John & Brown, Jo-Ann. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p234-237
The article provides information on the lecture of John Watkins, chief executive office (CEO) of Alzheimer's Australia NSW lecture about the dementia policy at the seminar "Ageing in Place-- Nutrition and Other Aspects," in New South Wales on June 10, 2009. Watkins described dementia as one of the country's major health problem and become the largest killer among Australians. He believed that effective policy initiative would help people with dementia achieve long-lasting and fulfilling lives..

8. Undernutrition and housebound older people
By Visvanathan, Renuka. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p238-242
This paper outlines approaches to dealing with undernutrition in the older person. Method: A series of case studies is presented to expose principles of practice for management of undernutrition in the older person.
Results: Screening is a necessary first step. A more in-depth assessment of those at-risk may reveal contributory factors that if addressed, would result in better nutritional health outcomes. Preservation of muscle mass through adequate caloric and protein intake and exercise is important. Nutritional supplementation has been shown to reduce mortality risk and improve weight. A daily multivitamin may offer some benefit. Weight loss is also seen commonly in older people with dementia. There is a need to understand why this occurs as this could guide management strategies. There is also a need to consider conservative management when dysphagia occurs in the later stages of dementia. Percutaneous endoscopic gastrostomy feeding may not necessarily have that much to offer.
Conclusion: In older people, the prevalence of undernutrition increases with increasing frailty. If not treated, undernutrition is costly both to the individual and society. [ABSTRACT FROM AUTHOR].

9. Dietary guidance for older Australians
By Truswell, A. Stewart. Nutrition & Dietetics, Dec 2009, Vol. 66 Issue 4: p243-248
This paper reviews the literature on dietary guidance for older Australians. Methods: The components of the 1999 National Health and Medical Research Council Dietary Guidelines for Older Australians are reviewed in conjunction with the current literature. Results: Advice on a healthy diet for older people from different professionals can sometimes seem to be looking in opposite directions in terms of amount and types of food to recommend. Appropriate nutritional guidance should be determined by the stage of ageing, not by chronological age. For those in the third age—older but still active—advice should be somewhat modified from the dietary guidelines for younger adults. For example, maintaining muscles and bones become more important than keeping a low body mass index.
Conclusions: The 1999 National Health and Medical Research Council Dietary Guidelines for Older Australians provide a sensible framework for considering recent evidence. In old people who are frail and losing weight, the ‘fourth age’, our main concern should be to prevent (further) malnutrition. The popular dietary rules of low calories, sugar, fat and salt no longer apply. [ABSTRACT FROM AUTHOR].

Journals - Table of Contents

10. Selected articles from Journal of Community Health Nursing, Jan-Mar 2010
10A. Parents' Food Choices: Obesity Among Minority Parents and Children
10B. Benefits and Barriers of Pap Smear Screening: Differences in Perceptions of Vietnamese American Women by Stage
10C. Influential Factors of Long-Term Care in a Japanese Rural Community Examined Through Interviews of Family Caregivers
10D. Immigrant Women's Cancer Screening Behaviors
10E. From Biloxi to Cape Town: Curricular Integration of Service Learning
10F. Meningococcal Meningitis: An Emerging Infectious Disease

11. Selected articles from Australian Nursing Journal, February 2011, Volume 18 Number 7
Floods bring tragedy - nurses respond; The aftermath - public health alert; ANF welcomes new preventive health agency
11B. Landmark nursing research centre established; Hurdle jumped in health reform [Boundaries for the new hospital and primary care networks in Australia's health reform agenda]
11C. Celebrating Vivian Bulwinkel at the 9th Vivian Bulwinkel lecture; Nurse-led clinics in demand; Calling all primary health care nurses
11D. Women's health policy targets chronic disease; Healthy respect for environment crucial for survival; Nurse researcher wins grant for aged care; SEATO nurses campaign to continue in 2011
11E. NSW - beds closed for ratios; TAS - Nurses and Midwives vote for EBA; VIC - ANF & ACTU support locked out workers; ACT - Push for new hospital; QLD - QNU recognised for going green!; SA - Public sector EB campaign wins award
Nurses rate well but room for improvement in hand hygiene
11G. Common learning outcomes in health - implications for nurses?
11H. Who should consent for older people in residential care?
11I. 42+ pieces in the primary health care reform puzzle
Integrating geriatric expertise into main-stream oncology care; Simulated learning in dementia care
11K. Reducing confusion in older patients; Impact of frequent deaths in aged care; Homosexual people 'invisible' in ageing policy
11L. CGMS for older people; Forging evidence based practice in aged care
11M. Recognising dying in acute care; New pathways from TAFE to university


12. ICN Conference - “Nurses Driving Access, Quality and Health”
Date: Wednesday, 4 May 2011
Venue: Malta
The three ICN pillars – Professional practice, Regulation and Socio-economic Welfare – will frame the scientific programme and the dynamic exchange of experiences and expertise.
More info:

News - National

13. Teams of 2 ensure patients get the best
Bay of Plenty Times - 18 February 2011
Nurses are teaming up with a new system aimed at strengthening patient safety and providing better continuity of care. The Wanganui trial started early last month with a view to rolling it out to the surgical ward next month. The system was introduced by Sandy Blake, the director of nursing at Whanganui District Health Board, and is based on similar nursing models she worked with in Queensland.

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