Retrieved Sep 17 from https: In the context of naturopaths, there is a high level of variability in adopted approaches to regulation. In particular, our team sought to assess the type of arguments used to support such regulatory changes, specifically exploring whether any empirical evidence defined here as non-anecdotal research, including categories set out by the Ontario Health Professions Regulatory Advisory Council: Indeed, many traditionally-recognized health professionals are required by their professional bodies to adopt an evidence-based approach, and provincial governments have stated a commitment to such an approach.
Advanced Search Abstract Objective: Sixteen were ineligible as they were immediately transferred to another acute ward, were managed conservatively or died preoperatively.
DA-supported participants were less likely to die in the acute ward 4. This effect was still apparent at 4 month follow-up Hip fracture accounts for 70, of these, and the advanced age and frailty of patients with this injury is reflected in the outcome of the injury.
Length of stay LOS in the orthopaedic ward averages between 2 and 3 weeks, and overall hospital stay may average as much as 5 weeks [ 2 ]. The reasons for poor recovery are complex, but poor nutrition is an important factor. In our own unit, we have shown that the result of Mini Nutritional Assessment [ 45 ] is an important predictor of poor outcome [ 6 ].
Some patients will need complex nutritional support, but most simply need encouragement and assistance to enable them to eat properly [ 78 ].
Specialist nurses in busy trauma wards may find it difficult to spend adequate time with patients who need such help at mealtimes. Several approaches to nutritional support following hip fracture have been studied, and a Cochrane Systematic Review [ 9 ] concluded that oral multinutrient feeds may reduce unfavourable outcome.
Intensive feeding support [ 1415 ] is particularly suited to patients with cognitive impairment, as individual patients can be closely supervised and encouraged to take oral nutritional support.
Methods Participants We approached all women over the age of 65 presenting to a single trauma ward with acute nonpathological hip fracture, between May and August Intervention Subjects were randomised either to receive the conventional pattern of nurse- and dietitian-led care, normally provided on the trauma unit which included the routine provision of oral nutritional supplements to all patients or to receive the additional personal attention of the DAs.
Two part-time DAs were appointed. They had no previous formal nutrition education, but both had some experience of working in the National Health Service NHS. They were given a 14 day period of orientation and training, and thereafter worked closely with the specialist dietitian.
Their duties were organised so that one DA was present on the ward 6 h per day, 7 days a week. DAs were asked to try to ensure that patients allocated to them received appropriate help in meeting their nutritional needs.
They did this in many ways, including: Primary outcome measure was postoperative mortality in the acute trauma unit. Secondary outcome measures were inpatient and 4 month mortality, LOS, acute ward complication rate, energy intake and nutritional status as assessed by anthropometric measurements.
Outcome assessment Assessments were based on the protocol of the Standardised Audit of Hip Fractures in Europe SAHFE [ 16 ] and performed on admission, at discharge from the acute trauma ward and at 4-month follow-up.
We supplemented inpatient assessments with Waterlow score of pressure sore risk [ 17 ], and Abbreviated Mental Test score [ 10 ], with records of all medical and surgical complications and a patient satisfaction questionnaire.
See Appendices 3 and 4 available as supplementary data on the journal website www. We approached the 4 month follow-up assessment using a postal questionnaire.
If no response was received, the participant or their carer was telephoned.
Date of death was confirmed with medical records or the audit department. Nutritional assessments As cognitive impairment is common in this patient population, a quantitative assessment of habitual food intake was complex. On the third postoperative day, the nurses and DAs kept an un-weighed semiquantitative dietary intake record.
Food and drink consumed was documented using descriptions of portion sizes. To validate portion sizes used in this approach, we performed a 3 day weighed food intake on days 3—6 after operation in a subset of 27 consecutive admissions over a 4 month period [ 18 ].
A further unpublished weighed food intake was undertaken in 24 women, during the second year of the trial. Mini Nutritional Assessment [ 45 ], anthropometric measurements weight, supine total arm length [ 19 ] to estimate height, mid-arm circumference and triceps skin-fold thicknesshandgrip strength and biochemical markers of nutritional status haemoglobin, lymphocyte count and serum albumin were all recorded on admission.
The serum albumin measurement was repeated in the third week after admission or at discharge from the unit if sooner. All other measurements were repeated at discharge.
Sample size Our trial was originally designed to look at LOS. Previous published studies showed median hospital LOS reductions of over a week, from 38 to 29 days [ 20 ] and from 40 to 24 days [ 21 ].
We subsequently obtained additional funding to permit a larger-scale project that could look at mortality.This article, in response to the recent report by the Association of Community Health Councils (CHCs) England and Wales ‘Hungry in Hospital’, explores nutrition in the hospitalized patient.
Nutrition is instrumental to health and perhaps, more importantly, ill health. School Health Guidelines to Promote Healthy Eating and Physical Activity This report includes nine general guidelines for school health programs to promote healthy eating and physical activity.
Each guideline is followed by a series of strategies for implementing the general guidelines. These changes are supported by the report by the Association of Community Health Councils highlighting problems with hospital catering.
26 The availability of snacks in-between meals was also initiated and has been shown to increase energy intake. 5 Since poor appetite and reduced food intake play a central role in the pathogenesis of.
The Strategic Review of Health Inequalities in England post (Marmot et al, ), concluded that studies that show association between proximity, or lack of, to healthy food, and health outcomes. Community Health News - The CHC News became a forum for CHC members and staff to exchange experiences, information and ideas.
Click on the issue number to download the article. Editor—Jacqui Wise's reference to the report by the Association of Community Health Councils for England and Wales highlights a serious problem.1 Although the report is anecdotal, the problems.