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The effect of diet education on the labvalues and knowledge of dialysis patients with hyperphosphatemia
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NONDAY,OCT(~BER22 POSTERSESSION:EDUCATIONAND BEHAVIORALSTRATEGIES/MEDICALNUTRITIONTHERAPY TITLE:
THE EFFECT OF FINELY PROCESSED FIBER FORTIFICATION AND COOKING TIME ON THE QUALITY OF COOKED PUDDING
AUTHOR(S): WJ Dahl MSc, RD, SJ Whiting PhD, GA Zello Phi) & JD Stanger, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada LEARNING O U T C O M E :
To identify the appropriate food vehicle for dietary fiber in long term care (LTC).
ABSTRACT TEXT: Although sufficient dietary fiber functions to prevent and treat constipation, dietary fiber intakes of many elderly LTC residents remain inadequate while constipation prevails. Increasing the dietary fiber content of LTC diets has relied on costly supplementation. We hypothesized that addition of fmely processed fiber to common institutional foods would be an effective and acceptable method of increasing fiber intakes of elderly LTC residents. We tested cooked and overcooked butterscotch pudding fortified with low (1.3 g) and high (2.6 g) fiber from finely processed pea hull (per 125 mL serving) added before or after cooking. A further aspect examined was standing time. A taste panel of 34 adults (< 50 y) evaluated the taste and texture of puddings using a 5 point Likert-type scale. The control pudding (0 g fiber) was highly acceptable for taste (score=4.4), with the "overcooked" control ranking second (score=3.7). The low fiber puddings were acceptable (range 3.1-3.6), but significantly less so than controls (!0<0.05); and puddings with high or overcooked with fiber were rated as unacceptable for taste (score <3). Texture was acceptable for the control pudding, and variable under different fiber contents, cooking states and standing times. We conclude that low levels of finely processed fiber can be added to pudding and remain acceptable. However, compared to our previous research on pureed food items, pudding may not be the preferred vehicle for fiber. Further research is required to determine how recipe modification increases acceptability of fiber fortification of food. (Supported by The Saskatchewan Pulse Crop Development Board)
THE EFFECT OF DIET EDUCATION ON THE LAB VALUES AND KNOWLEDGE OF DIALYSIS PATIENTS WITH HYPERPHOSPHATEMIA AUTHOR(S): J.K. Carroll, L.D.N., R.D., Fresenius Medical Care J.F. Pope, Ph.D., L.D.N., R.D., Louisiana Tech University B. Hackes, Ph.D., DTR, Louisiana Tech University A.E. Hunt, Ph.D., L.D.N., R.D., Louisiana Tech University LEARNING OUTCOME: TITLE:
To improve the knowledge and laboratory values of dialysis patients with hyperphosphatemia.
TITLE: OUTCOME STUDY: DEHYDRATION STATUS FOR
ENTERAL THERAPY RESIDENTS IN LONG-TERM CARE AUTHOR(S): Jennifer Barren BS, University of Memphis, Memphis, TN, Maria Sun MSRDLDN Beverly Healthcare, Memphis,TN LEARNING OUTCOME: To determine the outcomes of Nursing input output documentation for tube-fed residents in a long-term care setting. ABSTRACT TEXT: The executive director & a LTC requested the registered dietitian to monitor intake and output volurr~s for tube-fed residents to prevent dehydration. The documentation was monitored for the skilled units with goals of at least 75% for docum~tation and 100% for calculation. Eleven residents with enteral orders were randomly chosen from the skilled units. For a period of 60 days the input-ontput recorded volumes were monitored for documentation ( volumes were recorded 75%documentation was acceptable) and the errors (the total input-output were chocked for calculation errors) A data collection form was developed for the study and a reminder notice was distributed to all nursing staff and units on accurate documentation. The volume of fluid administered (formula and water flush volume ) w~re calculated and compared to the residents' fluid needs (based on kg. per 30cc). Descriptive statistics ,ehi square, and correlation analyses were used to evaluate the data ( P<.05 ). There was a statistical difference between the document and error peremtage score (P = .03), a significant difference among the docum~atation grades (n=l 1)(P=.04) The mean difforencas for error score was 66.5 (n=5) and the documentation score 75 (n--4) There were no significant differences of performance per nursing unit station. Results of the investigation indicate the need for nursing staffto receive formal retraining on input-output documentation and importance o f hydration for LTC enteral fed residents.
TITLE: A PILOT INVESTIGATION OF THE MICROBIAL
CONTAMINATION OF HERBAL SUPPLEMENTS: A POTENTIAL RISK FOR IMMUNOCOMPROMISED POPULATIONS AUTHORS: B. Kineman, M.L.Nahikian-Nelms,PhD,RD. C. Frazier, PhD, N. Somarajan and V. Galati, Departments of Biology and Human Environmental Studies, Southeast Missouri State University, Cape Girardeau, Me. LEARNING OUTCOME: To provide preliminary data regarding microbiological safety of common herbal supplements used by immunocompromised populations.
ABSTRACT TEXT: It is estimated that fifty percent of hemodialysis patients experience elevated serum phosphorus levels. The purpose of this study was to evaluate the effectiveness of 20-30 minutes per month of additional education on monthly lab values in hemodialysis patients with hyperphosphatemia. Based on a three-month average serum phosphorus >6.0 mg/dl, 70 patients from three northwest Louisiana dialysis centers were selected for participation in the study. Half wea:e assigned to the control group and half to the intervention group. Both groups took pre and post knowledge test and monthly laboratory values (serum phosphorus, calcium, PTH, and calcium/phosphorus product) were determined. In addition, patients in both groups participated in monthly routine laboratory reviews with the registered dietitian. The intervention group received 20-30 minutes per month of additional dietary education specifically targeting phosphorus. At baseline, there was no significant difference in any of the laboratory values, but the knowledge level of the intervention group was greater (p <.05). After six months, gains in knowledge were significantly higher in the intervention group and serum phosphorus and calcium/phosphorus product were significantly lower (io <.01). These results suggest that those patients who received extra education monthly exhibited positive changes that will be beneficial in combating hyperphosphatemia.
ABSTRACT TEXT: Alternative medical therapies, including herbal remedies, have become an increasing source of treatment. The current federal regulation allows for the commercialization of herbal supplements without the FDA's safety and efficacy tests. This presents a potential danger of contamination with microorganisms for immunosuppressed patients. Six herbs were surveyed for bacterial and fungal contamination: Echinacea, Ginseng, St. John's Wort, Milk Thistle, Kava Kava, and Garlic. Each was obtained from three sources: a local co-op, a national supermarket, and H1V-positive patients. The herb samples were cultured on Trypticase soy agar (TSA), Brain heart infusion agar (BHI), Maconkey agar, Potato dextrose agar (PDA), and Blood agar and assayed for microbial growth. Bacteria and yeast isolates were identified using a Vitek rM identification system; molds were identified microscopically. The Echinacea and St. John's Wort co-op samples; the patient and national manufacturer Milk Thistle samples; one national manufacturer garlic sample; and all Kava Kava samples were contaminated with a variety of microorganisms. Pantoea
(Enterobacter) agglomerans, Sphingomonas (pseudomonas) paucimobili, Enterococcus cassel~flavus, Klebsiellapneumoniae, Morganella morgani, Enterobacter cloacae, Escherichia vulneris, Staphylococcus epidermidis, Rhodotorula mucilaginosa, and Aspergillus niger were identified and all potentially serve as sources of opportunistic infections. Identification of contaminants indicates that herbal supplements pose a potential threat to immunosuppressed individuals. Federal regulation needs to be placed on the manufacturing and commercialization of herbal supplements. Guidelines need to be established to aid in the preparation and use of herbal supplements.
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-59
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o o t * * * * o l * * * * . o o * l o * a e t * * o * * * * o * * * o * * * * * o * * o *
NONDAY,OCT(~BER22 POSTERSESSION:EDUCATIONAND BEHAVIORALSTRATEGIES/MEDICALNUTRITIONTHERAPY TITLE:
THE EFFECT OF FINELY PROCESSED FIBER FORTIFICATION AND COOKING TIME ON THE QUALITY OF COOKED PUDDING
AUTHOR(S): WJ Dahl MSc, RD, SJ Whiting PhD, GA Zello Phi) & JD Stanger, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada LEARNING O U T C O M E :
To identify the appropriate food vehicle for dietary fiber in long term care (LTC).
ABSTRACT TEXT: Although sufficient dietary fiber functions to prevent and treat constipation, dietary fiber intakes of many elderly LTC residents remain inadequate while constipation prevails. Increasing the dietary fiber content of LTC diets has relied on costly supplementation. We hypothesized that addition of fmely processed fiber to common institutional foods would be an effective and acceptable method of increasing fiber intakes of elderly LTC residents. We tested cooked and overcooked butterscotch pudding fortified with low (1.3 g) and high (2.6 g) fiber from finely processed pea hull (per 125 mL serving) added before or after cooking. A further aspect examined was standing time. A taste panel of 34 adults (< 50 y) evaluated the taste and texture of puddings using a 5 point Likert-type scale. The control pudding (0 g fiber) was highly acceptable for taste (score=4.4), with the "overcooked" control ranking second (score=3.7). The low fiber puddings were acceptable (range 3.1-3.6), but significantly less so than controls (!0<0.05); and puddings with high or overcooked with fiber were rated as unacceptable for taste (score <3). Texture was acceptable for the control pudding, and variable under different fiber contents, cooking states and standing times. We conclude that low levels of finely processed fiber can be added to pudding and remain acceptable. However, compared to our previous research on pureed food items, pudding may not be the preferred vehicle for fiber. Further research is required to determine how recipe modification increases acceptability of fiber fortification of food. (Supported by The Saskatchewan Pulse Crop Development Board)
THE EFFECT OF DIET EDUCATION ON THE LAB VALUES AND KNOWLEDGE OF DIALYSIS PATIENTS WITH HYPERPHOSPHATEMIA AUTHOR(S): J.K. Carroll, L.D.N., R.D., Fresenius Medical Care J.F. Pope, Ph.D., L.D.N., R.D., Louisiana Tech University B. Hackes, Ph.D., DTR, Louisiana Tech University A.E. Hunt, Ph.D., L.D.N., R.D., Louisiana Tech University LEARNING OUTCOME: TITLE:
To improve the knowledge and laboratory values of dialysis patients with hyperphosphatemia.
TITLE: OUTCOME STUDY: DEHYDRATION STATUS FOR
ENTERAL THERAPY RESIDENTS IN LONG-TERM CARE AUTHOR(S): Jennifer Barren BS, University of Memphis, Memphis, TN, Maria Sun MSRDLDN Beverly Healthcare, Memphis,TN LEARNING OUTCOME: To determine the outcomes of Nursing input output documentation for tube-fed residents in a long-term care setting. ABSTRACT TEXT: The executive director & a LTC requested the registered dietitian to monitor intake and output volurr~s for tube-fed residents to prevent dehydration. The documentation was monitored for the skilled units with goals of at least 75% for docum~tation and 100% for calculation. Eleven residents with enteral orders were randomly chosen from the skilled units. For a period of 60 days the input-ontput recorded volumes were monitored for documentation ( volumes were recorded 75%documentation was acceptable) and the errors (the total input-output were chocked for calculation errors) A data collection form was developed for the study and a reminder notice was distributed to all nursing staff and units on accurate documentation. The volume of fluid administered (formula and water flush volume ) w~re calculated and compared to the residents' fluid needs (based on kg. per 30cc). Descriptive statistics ,ehi square, and correlation analyses were used to evaluate the data ( P<.05 ). There was a statistical difference between the document and error peremtage score (P = .03), a significant difference among the docum~atation grades (n=l 1)(P=.04) The mean difforencas for error score was 66.5 (n=5) and the documentation score 75 (n--4) There were no significant differences of performance per nursing unit station. Results of the investigation indicate the need for nursing staffto receive formal retraining on input-output documentation and importance o f hydration for LTC enteral fed residents.
TITLE: A PILOT INVESTIGATION OF THE MICROBIAL
CONTAMINATION OF HERBAL SUPPLEMENTS: A POTENTIAL RISK FOR IMMUNOCOMPROMISED POPULATIONS AUTHORS: B. Kineman, M.L.Nahikian-Nelms,PhD,RD. C. Frazier, PhD, N. Somarajan and V. Galati, Departments of Biology and Human Environmental Studies, Southeast Missouri State University, Cape Girardeau, Me. LEARNING OUTCOME: To provide preliminary data regarding microbiological safety of common herbal supplements used by immunocompromised populations.
ABSTRACT TEXT: It is estimated that fifty percent of hemodialysis patients experience elevated serum phosphorus levels. The purpose of this study was to evaluate the effectiveness of 20-30 minutes per month of additional education on monthly lab values in hemodialysis patients with hyperphosphatemia. Based on a three-month average serum phosphorus >6.0 mg/dl, 70 patients from three northwest Louisiana dialysis centers were selected for participation in the study. Half wea:e assigned to the control group and half to the intervention group. Both groups took pre and post knowledge test and monthly laboratory values (serum phosphorus, calcium, PTH, and calcium/phosphorus product) were determined. In addition, patients in both groups participated in monthly routine laboratory reviews with the registered dietitian. The intervention group received 20-30 minutes per month of additional dietary education specifically targeting phosphorus. At baseline, there was no significant difference in any of the laboratory values, but the knowledge level of the intervention group was greater (p <.05). After six months, gains in knowledge were significantly higher in the intervention group and serum phosphorus and calcium/phosphorus product were significantly lower (io <.01). These results suggest that those patients who received extra education monthly exhibited positive changes that will be beneficial in combating hyperphosphatemia.
ABSTRACT TEXT: Alternative medical therapies, including herbal remedies, have become an increasing source of treatment. The current federal regulation allows for the commercialization of herbal supplements without the FDA's safety and efficacy tests. This presents a potential danger of contamination with microorganisms for immunosuppressed patients. Six herbs were surveyed for bacterial and fungal contamination: Echinacea, Ginseng, St. John's Wort, Milk Thistle, Kava Kava, and Garlic. Each was obtained from three sources: a local co-op, a national supermarket, and H1V-positive patients. The herb samples were cultured on Trypticase soy agar (TSA), Brain heart infusion agar (BHI), Maconkey agar, Potato dextrose agar (PDA), and Blood agar and assayed for microbial growth. Bacteria and yeast isolates were identified using a Vitek rM identification system; molds were identified microscopically. The Echinacea and St. John's Wort co-op samples; the patient and national manufacturer Milk Thistle samples; one national manufacturer garlic sample; and all Kava Kava samples were contaminated with a variety of microorganisms. Pantoea
(Enterobacter) agglomerans, Sphingomonas (pseudomonas) paucimobili, Enterococcus cassel~flavus, Klebsiellapneumoniae, Morganella morgani, Enterobacter cloacae, Escherichia vulneris, Staphylococcus epidermidis, Rhodotorula mucilaginosa, and Aspergillus niger were identified and all potentially serve as sources of opportunistic infections. Identification of contaminants indicates that herbal supplements pose a potential threat to immunosuppressed individuals. Federal regulation needs to be placed on the manufacturing and commercialization of herbal supplements. Guidelines need to be established to aid in the preparation and use of herbal supplements.
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-59