• 대한영양사협회학술지
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• 제18권3호
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• pp.266-275
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• 2012

The purpose of this study was to evaluate the perception and needs of doctors on clinical nutrition services. A cross-sectional survey design was used. The doctors' perception and needs were assessed by questionnaires that had been specifically designed for the study. The research was conducted from February 14 to March 15, 2011 for 544 doctors at 42 large hospitals (with over 400 beds). Ninety-eight percent of doctors responded that clinical nutrition service was important. The mean scores of importance on clinical nutrition service were 4.45 for 'nutrition screening at admission', 4.50 for 'treatment of malnutrition', and 4.43 for 'nutrition education and counseling'. The mean scores of needs for clinical nutrition service were 4.42 for 'individual nutrition counseling & education' 4.39 for 'nutrition management for malnourished patients' and 'nutrition management for tube fed patients'. The medical specialists showed significantly (P<0.01) higher scores than the residents on the importance and needs for clinical nutrition services. Eighty-five percent of the doctors recognized the necessity of the specialized dietitians classified by diseases. The medical specialists (93.8%) showed significantly (P<0.01) higher recognition of this necessity than the residents (77.7%). The low residents' perceptions of the importance and needs for clinical nutrition services will necessitate clinical nutrition education plans. The departments of clinical nutrition in universities should improve the ability and skills of the clinical dietitians.

• 대한영양사협회학술지
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• 제2권2호
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• pp.199-215
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• 1996

In Korea, the majority of hospital dietitians expend most of their time performing food management related activities, and only a few carry out nutrition care activities in full-time. This study was designed to measure productivity of the clinical nutrition team and assess the role of clinical dietitians in the only 2200-bed teaching hospital in Korea. Six full-time clinical dietitians collected time data for four weeks according to the nutrition care activities outlined. Three clinical dietitians assigned to 7 units recorded how often physicians implemented their recommendations for two months. Two kinds of survey questionaire were developed and sent to the patients and the health care team. The followings are a summary of the results. 1. The clinical nutrition team of 6 full-time dietitians expended 75% of their time performing patient care activities, 20% in non-patient care activities and 5% in delay and transit. 2. Each clinical dietitian assigned to the units carried out 56 patient care activities on daily basis. 3. The average time required for the clinical nutrition services was 60.2 minutes for outpatient counseling, 89 minutes for inpatient counseling, 72.5 minutes for nutrition management, 95 minutes for malnutrition consult and 121 minutes for dysphagia diet management. 4. Physicians' implementation of clinical dietitians' recommendations was 98.5%. 5. Most physicians and nurses viewed the clinical dietitians on the units assertive, contributing to the quality improvement of medical services, and helpful to the patients as well as the health care team. 6. Most patients viewed the clinical dietitians on the units considerate, attentive and helpful. Based on these results, it is suggested that (1) daily meal round and nutrition care monitoring are effective tools for nutrition intervention in the hospital setting. (2) unit assignment of clinical dietitians enhances the patients' satisfaction in the nutrition services provided as well as the perceptions of health care team on clinical dietitian's expertise.

• 대한영양사협회학술지
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• 제20권4호
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• pp.235-246
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• 2014

The purpose of this study was to evaluate nurses' perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20 general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses' experience in group education on cancer at capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The mean scores of perceived importance of clinical nutrition services were 4.46/5.00 for 'group nutrition education', 4.46/5.00 for 'individual consultation', and 4.40/5.00 for 'nutrition management for enteral nutrition (EN) patients'. The most common reason why clinical nutrition services are important was 'improving malnutritional status'. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.

• 대한영양사협회학술지
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• 제20권3호
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• pp.199-211
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• 2014

The increasing elderly population has created an urgent need for well-managed convalescent hospitals, which should provide appropriate clinical nutrition services. The new accreditation policy requiring participation of all convalescent hospitals since 2013 may promote improvement of clinical nutrition services. This study examined whether or not the accreditation policy has increased practice level and dietitians' perception of the importance of clinical nutrition management. Of the 177 convalescent hospitals accredited by January 30, 2014, dietitians from 73 hospitals (41.2%) completed the survey questionnaire. The pre-tested questionnaire surveyed general characteristics of the hospital and dietitians, current status of clinical nutrition management, and changes in the perception and practice levels of various aspects of food and clinical nutrition management. In average, dietitians with more than 5 years of work experience (68.1%) provided food and clinical nutrition services (71.2%). After accreditation, dietitians' perception of the importance and practice level of clinical nutrition service increased (P<0.001). Level of perception, however, was significantly (P<0.001) higher than practice level before and after accreditation. During perception and practice level of initial nutrition assessment, a compulsory accreditation item, notably and significantly (P<0.001) improved after accreditation. The significant difference between perception and practice level disappeared after accreditation. In conclusion, the accreditation process had positive effects on clinical nutrition management in terms of dietitians' perception and practice levels. Making more accreditation items compulsory and providing motivation and professional education to dietitians in convalescent hospitals could lead to additional improvements.

• Genomics & Informatics
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• 제16권4호
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• pp.26.1-26.12
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• 2018

Shigella spp. constitutes some of the key pathogens responsible for the global burden of diarrhoeal disease. With over 164 million reported cases per annum, shigellosis accounts for 1.1 million deaths each year. Majority of these cases occur among the children of the developing nations and the emergence of multi-drug resistance Shigella strains in clinical isolates demands the development of better/new drugs against this pathogen. The genome of Shigella flexneri was extensively analyzed and found 4,362 proteins among which the functions of 674 proteins, termed as hypothetical proteins (HPs) had not been previously elucidated. Amino acid sequences of all these 674 HPs were studied and the functions of a total of 39 HPs have been assigned with high level of confidence. Here we have utilized a combination of the latest versions of databases to assign the precise function of HPs for which no experimental information is available. These HPs were found to belong to various classes of proteins such as enzymes, binding proteins, signal transducers, lipoprotein, transporters, virulence and other proteins. Evaluation of the performance of the various computational tools conducted using receiver operating characteristic curve analysis and a resoundingly high average accuracy of 93.6% were obtained. Our comprehensive analysis will help to gain greater understanding for the development of many novel potential therapeutic interventions to defeat Shigella infection.

• 대한영양사협회학술지
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• 제21권1호
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• pp.37-56
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• 2015

This study was conducted to develop job standards for clinical dietitian administering clinical nutrition therapy to diabetic patients in hospitals. Based on DACUM (Developing A Curriculum) analysis of 17 members including clinical dietitians, professors majoring in clinical nutrition and researchers, information on duties, tasks and task elements of clinical dietitians for diabetes care were derived and applied to diabetes mellitus-specific clinical nutrition care in hospitals for evaluation. The final developed job standards for clinical dietitians for diabetes care included four duties, 19 tasks and 56 task elements. The duties consisted of nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring evaluation. For application of diabetes mellitus-specific job standards in clinical nutrition care, 108 work activities were developed and classified into 90 basic and 18 recommended types. Performance rates of standardized jobs were 80.2% at nutrition assessment, 99.6% at nutrition diagnosis, 78.5% at nutrition intervention, and 32.9% at nutrition monitoring evaluation. These results can be applied as guidelines to implement jobs for diabetes mellitus-specific clinical nutrition services in clinical settings. In addition, they would be useful for education standards in educational institutions for education and training of clinical dietitian.

• Journal of Nutrition and Health
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• 제50권5호
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• pp.519-529
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• 2017

임상영양서비스에 대한 의사의 인식과 임상영양사 요구도에 대한 의사의 인식에 대한 인과관계를 명확하게 파악하기 위해 매개효과를 분석하고 부트스트래핑으로 매개효과를 검증한 이 연구의 결과물을 요약하면 다음과 같다. 연구목적을 달성하기 위해 5가지 가설을 다음과 같이 세웠다. 가설 1. '의사가 인식하는 임상영양서비스의 실행에 대한 의사의 인식'은 '임상영양서비스의 중요도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 2. 의사가 인식하는 '임상영양서비스의 질병 치료 효과에 대한 의사의 인식'은 '임상영양서비스 중요도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 3. '임상영양서비스의 중요도에 대한 의사의 인식'은 '임상영양사 요구도에 대한 의사의 인식'에 정(+)의 영향을 줄 것이다. 가설 4. '임상영양서비스 중요도에 대한 의사의 인식'은 '임상영양서비스 실행에 대한 의사의 인식'과 '임상영양사 요구도에 대한 의사의 인식' 사이에서 매개역할을 할 것이다. 가설 5. '임상영양서비스 중요도에 대한 의사의 인식'은 '임상영양서비스의 질병 치료 효과에 대한 의사의 인식'과 '임상영양사 요구도에 대한 의사의 인식' 사이에서 매개역할을 할 것 이다. 가설검증 결과와 매개효과 분석 결과 가설 1~5까지의 가설이 모두 지지되었다. 결론적으로 1) '임상영양서비스의 중요도에 대한 의사의 인식'이 완전 매개로 작용한 경우는 임상영양서비스 실행 횟수에 상관없이 의사가 임상영양서비스의 중요도를 인식해야만 임상영양사 요구도를 인식한다는 것이며, 2) 임상영양서비스의 중요도에 대한 의사의 인식이 불완전 매개로 작용한 경우는 임상영양서비스의 질병 치료 효과에 대한 의사의 인식과 임상영양서비스 요구도에 대한 의사의 인식 사이에서 프로세스 역할을 수행하지만, 임상영양서비스의 질병 치료 효과에 대한 의사의 인식이 임상영양서비스 요구도에 대한 의사의 인식에 더 큰 영향을 준다는 것이다. 따라서 임상영양서비스에 대한 의사들의 긍정적인 인식은 임상영양사 요구도에 대한 의사의 인식을 높이지만, 단순히 임상영양서비스의 양적 횟수 즉 임상영양서비스의 실행에 대한 의사의 인식이 아니라 환자 치료에 있어서 도움이 되는 질적 효과 즉 임상영양서비스의 질병 치료효과에 대한 의사의 인식과 임상영양서비스의 중요도에 대한 의사의 인식이 의사들에게서 임상영양서비스에 대한 긍정적인 인식을 이끌어 낼 수 있다. 이러한 의료진의 긍정적인 인식을 높이기 위해서는 추가적으로 임상영양서비스를 수행하는 임상영양사의 전문성이 요구된다. 이상의 결과를 근거로 임상영양서비스에 대한 의사의 인식이 임상영양사 요구도에 영향을 준다고 여겨진다. 더불어 영양학 분야의 유사연구에서 사회과학 분야 통계기법을 활용하여 명확한 인과관계를 규명하는데 본 연구가 발판이 되어 질 것으로 기대하는 바이다.

• 대한영양사협회학술지
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• 제21권2호
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• pp.91-109
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• 2015

The present study was conducted to provide the basis for improvement of clinical nutrition services through development of job standards of clinical dietitian for the clinical nutrition therapy to cancer patients in hospitals. Developing A Curriculum (DACUM) method was used for job analysis and development of job standards for clinical dietitians for cancer care. Based on DACUM analysis, information about duties, tasks, and task elements of clinical dietitians for cancer care was collected. Developed job standards were applied to clinical nutrition care for cancer patients in hospitals for evaluation. Based on DACUM analysis, consultations from professionals, and field application tests, the final job standards were composed of four duties, 18 tasks, and 56 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring evaluation. For cancer nutrition care, 109 work activities were developed. They were composed of 75 basic and 34 recommended work activities. The application of developed job standards for clinical dietitians for cancer care at 10 hospitals showed a performance rate of 72.3%. In conclusion, job standards for clinical dietitians for cancer care developed in this study might be effectively used as guidelines for providing clinical nutrition services for cancer patients in hospitals.

• 대한영양사협회학술지
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• 제19권1호
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• pp.69-81
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• 2013

The purpose of this study was to evaluate the difference in perception of clinical nutrition service (CNS) between doctors and dietitians working in hospitals in Busan and the Gyeongnam area. Research was performed through questionnaires (from November to December 2011) at over 100 beds. 73.3% of dietitians were aware of the Nutrition Support Team (NST), while only 15.6% of doctors were aware of it. Due to heavy work and lack of medical staff, doctors didn't participate in NST, although most of them recognized the necessity of NST. 61.7% of dietitians screened and managed malnourished patients, whereas only 29.8% of doctors did. The main reason dietitians didn't treat malnourished patients was the absence of a treatment system in the hospital. Less than 50% of dietitians participated in the doctor's round to malnourished patients. As for why dietitians didn't participate in doctor's rounds, 71% of doctors chose understaffed dietitians and 38.1% of dietitians chose the doctors' unawareness of the importance of the dietitian in doctor's rounds. For the lower rate of nutrition counseling in provincial regions, compared to the capital region, 46.8% of doctors cited a lack of connection between doctors and clinical dietitians, while 43.3% of dietitians cited the lack of doctors' awareness on the importance of nutrition counseling. Although 87.3% of the doctors and 91.6% of the dietitians answered that CNS is important for treatment, the perception of onsite performance status on CNS was found to be low in both groups. 48.9% of doctors and 50.0% of dietitians regarded dietitians in the hospital as personnel in charge of food services, rather a member of the medical team. To improve the awareness of the importance of the CNS, and the image of clinical dietitians, 31.2% of doctors answered "to introduce a professional dietitian license for each disease" and 26.7% of dietitians answered "to change the system in the hospital". Most subjects found that a separation of clinical nutrition services from the food service part is needed. These results suggest that it is important to narrow the difference in perceptions of clinical nutrition services between doctors and dietitians for an organized clinical nutrition management of patients in hospitals in Busan and the Gyeongnam area.

• 한국임상약학회지
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• 제30권3호
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• pp.143-148
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• 2020

Objective: This study aimed to investigate pharmaceutical care for critically ill neonates and suggest targeted strategies compatible with the Korean health-system pharmacy. Methods: Articles that reported pharmacy practices for critically ill neonates were reviewed. Pharmaceutical care practices and roles of neonatal pharmacists were identified, and criteria were developed for neonates in need of specialized care by clinical pharmacists. Results: Neonatal pharmacists play many roles in the overall medication management pathway. For clinical decision support, multidisciplinary ward rounds, clinical pharmacokinetic services, and consultation for pharmacotherapy and nutrition support were conducted. Prevention and resolution of drug-related problems through review of medication charts contributed to medication safety. Pharmaceutical optimization of intravenous medication played an important role in safe and effective therapy. Information on the use of off-label medicine, recommended dosage and dosing schedules, and stability of intravenous medicine was provided to other health professionals. Most clinical practices for neonates in Korea included therapeutic drug monitoring and nutrition support services. Reduction in medication errors and adverse drug reactions, shortening the duration of weaning medicines, decreasing the use and cost of antimicrobials, and improvement in nutrition status were reported as the outcomes of pharmacist-led interventions. The essential criteria of pharmaceutical care, including for patients with potential high-risk factors for drug-related problems, was developed. Conclusion: Pharmaceutical care for critically ill neonates varies widely. Development and provision of standardized pharmaceutical care for Korean neonates and a stepwise strategy for the expansion of clinical pharmacy services are required.