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Objective: This systematic review addressed the effects of the competency level of medical students, physicians, and practitioners in nutrition education for optimum patient care. It also addresses the perceived inadequate didactic contact hours of nutrition education. Method: There were 55 studies selected, and 25 were used for this review including quantitative and qualitative studies. The data were divided into four groups: quantitative data, qualitative data, reports, and news articles. The categorization of the literature was as follows: 17 quantitative, 2 qualitative, 4 news articles, 1 manual, and 1 symposium report. These were evaluated to produce a credible qualitative meta-analysis of available data. Data Sources: The systematic review used databases and citation indexes including Embosses, PubMed, JAMA Network, Medline, Elsevier, and Oxford Academics, these include journals, reports of Symposiums, and news articles to ascertain evidence-based data Results: The findings of this review revealed the significant effect inadequate contact nutrition education has on the competency level of medical students, physicians, and practitioners. Limitations: Limitations of this review include several external factors. Although universities are expected to implement approximately 44 hours of nutrition education for the competency level of medical students and physicians during their tenure, this may not be the case at all schools. Many offer only 15-25 didactics hours. In addition, in some cases, the comparisons are not equal but the researcher was unable to establish the hours and a basic curriculum structure.
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Resumo Este ensaio, que traz contribuições póstumas da primeira autora, parte da compreensão da interseccionalidade como ferramenta teórica-metodológica e oferenda analítica que evidencia como sistemas múltiplos de subordinação e discriminação, suas consequências e dinâmicas estruturais, se relacionam entre dois ou mais eixos de opressão social. Propomos uma aproximação epistemológica entre esta compreensão e o campo da Alimentação e Nutrição, que contribua para pensar um cuidado alimentar e nutricional interseccional e uma práxis integral. Corroborando a metáfora da intersecção (e da encruzilhada), afirmamos que vários eixos de poder - raça, gênero, sexualidade, etnia, idade, classe, tamanho corporal, (dis)capacidades, entre outros - conformam as avenidas que estruturam o terreno do cuidado em saúde, inclusive o alimentar e nutricional. Entre tais avenidas e encruzilhadas, traçamos uma proposição inicial de Nutrição Clínica Ampliada e Implicada. Entre as implicações propostas, destacamos a reflexividade e a ação nas relações de poder e opressão, situando o(a) nutricionista como agente político, implicado com práxis emancipatórias, participativas e referenciadas socialmente. A interseccionalidade se traveste aqui como estratégia para o trabalho de justiça social, incluindo nesta a alimentação e a nutrição. Tratamos de relações em construção, constituindo práticas reflexivas, de composição de sentidos no ato do trabalho vivo alimentar e nutricional.
Abstract This essay, which brings posthumous contributions from the first author, starts from the understanding of intersectionality as a theoretical-methodological tool and analytical offering that shows how multiple systems of subordination and discrimination, their consequences and structural dynamics, relate between two or more axes of social oppression. We propose an epistemological approximation between this understanding and the field of Eating and Nutrition, which contributes to thinking an intersectional eating and nutritional care and an integral praxis. Corroborating the intersection (and crossroads) metaphor, we state that several axes of power - race, gender, sexuality, ethnicity, age, class, body size, (dis)abilities, among others - shape the avenues that structure the field of health care, including eating and nutritional care. Among such avenues and crossroads, we outline an initial proposal of an Extended and Implicated Clinical Nutrition. Among the proposed implications, we highlight reflexivity and action in power and oppression relations, placing the nutritionist as a political agent, involved with emancipatory, participatory, and socially referenced praxis. Intersectionality, therefore, is treated here as a strategy for social justice work, including eating and nutrition. We deal with relationships under construction, constituting reflective practices, the composition of meanings in the act of living eating and nutrition work.
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Introdução: a desnutrição representa um problema clínico-nutricional frequente em pacientes hospitalizados, sendo que a detecção precoce do risco nutricional torna-se fundamental, pois possibilita à equipe multidisciplinar o início imediato de uma conduta dietética adequada, minimizando o sinergismo entre a desnutrição e os demais fatores clínicos. Objetivo: determinar o risco nutricional, associando com o estado nutricional, estilo de vida e variáveis clínicas de hospitalização de pacientes internados pelo SUS, comparando tais condições entre os sexos. Metodologia: trata-se de estudo transversal. Para avaliação do risco nutricional dos pacientes hospitalizados foi utilizado o protocolo de triagem nutricional Nutricional Risk Screening (NRS) 2002, além disso foram coletados dados antropométricos, clínicos, sociodemográficos e dietéticos para comparação com o risco nutricional. Resultados: a amostra foi composta por 100 pacientes, sendo 50% adultos e 50% idosos, com média de idade de 56,11±19 anos, sendo a maioria do sexo masculino (51%). O risco nutricional esteve presente em 34% dos pacientes avaliados, sendo 58,8% no sexo feminino e 41,2% no sexo masculino. Não houve diferença das demais variáveis quando comparadas entre os sexos (p>0,05). A maior prevalência de risco observada foi em idosos (27%). Conclusão: o risco nutricional obteve maior prevalência nos pacientes idosos, porém não houve diferença entre os sexos. Sabe-se que a presença de comorbidades e uma inadequada aceitação da dieta por parte dos mesmos pode levar a uma piora significativa do estado nutricional.
Malnutrition is a frequent clinical and nutritional problem in hospitalized patients, and early detection of nutritional risk is essential, as it allows the multidisciplinary team to immediately start an adequate dietary approach, minimizing the synergism between malnutrition and other clinical factors. Objective: to determine the nutritional risk, associating it with the nutritional status, lifestyle and clinical variables of hospitalization of patients hospitalized by the SUS, comparing such conditions between the sexes. Methodology: this are a cross-sectional study. To assess the nutritional risk of hospitalized patients, the Nutritional Risk Screening (NRS) 2002 protocol was used. In addition, anthropometric, clinical, sociodemographic and dietary data were collected for comparison with nutritional risk. Results: the sample consisted of 100 patients, 50% adults and 50% elderly, with a mean age of 56.11±19 years, the majority being male (51%). Nutritional risk was present in 34% of the patients evaluated, being 58.8% female and 41.2% male. There was no difference in the other variables when compared between the sexes (p>0.05). The highest prevalence of risk observed was in the elderly (27%). Conclusion: nutritional risk was more prevalent in elderly patients, but there was no difference between the sexes. It is known that the presence of comorbidities and an inadequate acceptance of the diet by them can lead to a significant worsening of the nutritional status.
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Humans , Male , Female , Adult , Middle Aged , Weight Loss , Malnutrition , Eating , Nutrology , Hospitalization , Comorbidity , Cross-Sectional StudiesABSTRACT
Objective:To explore the application of clinical case analysis and practice-oriented teaching mode in the top-up teaching of Clinical Nutrition Nursing. Methods:Traditional teaching methods were adopted to the top-up nursing students of Shanghai University of Traditional Chinese Medicine in Batch 2018 (Class A). The top-up nursing students of Shanghai University of Traditional Chinese Medicine in Batch 2019 (Class B) adopted the teaching method of focusing on process teaching and combining clinical case teaching, case analysis report and practice. At the end of teaching, the teaching effect was evaluated through course assessment and questionnaire survey. SPSS 18.0 was used for t test. Results:Students' self-evaluation showed that the evaluation of teaching effect in Class B was higher than that in Class A with significant differences ( P<0.05). The scores of Class A were (83.34±4.27) points, and those of Class B were (85.07±4.22), with significant differences ( P<0.05). Conclusion:The teaching model based on clinical case analysis and practice has achieved good teaching effect on the teaching of Clinical Nutrition Nursing, which is worthy of promotion in the teaching of nursing major.
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Objective:To explore the complications and nutritional outcomes of Home Enteral Nutritional (HEN) in newborn surgical patients.Method:The medical records of neonates with HEN after surgery between 2017 and 2020 were retrospectively reviewed and complications of HEN and the nutritional status before and after HEN were analyzed.Results:A total of 66 neonates were included. The average gestational age at delivery and birth weight were (35.7 ± 3.0) weeks and (2426 ± 709) g, respectively. Diagnoses were mainly congenital esophageal atresia and intestinal diseases, such as intestinal atresia, intestinal torsion and necrotizing enterocolitis. The median age at HEN initiation was 92 (50, 112) days and HEN duration was 64 (41,95) days. HEN was conducted with tube feeding, with 14 patients (21.2%) through gastrostomy, 52 (78.8%) through nasal feeding tube, 20 (30.3%) through intermittent bolus infusion and 46 (69.7%) through continuous infusion. As for the formulas, 19 patients (28.8%) were given whole protein formula, 33 (50%) extensively hydrolyzed formula and 14 (21.2%) free amino acid-based formula. During the follow-up, 10 patients (71.4%) in gastrostomy group experienced 18 cases of catheter-related complications, including accidental removal (6 patients, 42.8%), catheter displacement (4 patients, 18.6%) and excessive granulation tissue at the gastrostomy site (4 patients, 18.6%). In nasal tube feeding group, 14 patients (26.9%) experienced 21 cases of catheter-related complications, including accidental tube removal (19 cases in 12 patients, 23.1%) and tube breakage (2 patients, 3.8%). Both the weight for age Z score and the height for age Z score were improved after HEN.Conclusions:HEN can help to improve the nutrition status in postoperative neonates. Management of catheter-related complications is challenging and warrants team work to improve the outcome of HEN.
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The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.
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Precision medicine emphasizes formulating reasonable diagnosis, treatment and prevention strategies according to patients′ different genotypes, metabolic characteristics, lifestyle and environment. It is the frontier and development direction of modern medicine. As an important branch of precision medicine, precision nutrition has attracted extensive attention. On the one hand, metabolomics and nutriomics researches based on gene level have become hot spots in this field, but it will take some time to apply it to clinical practice; On the other hand, based on the concept of "precision", the practice of individualized nutrition diagnosis and treatment centered on phenotypic characteristics is gradually carried out in various clinical medical fields, reflecting good application value. With the research progress, precision nutrition will be better combined with clinical nutrition to benefit patients.
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To investigate the effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). One hundred and twelve patients with GDM in the second trimester of pregnancy were recruited from Women's Hospital, Zhejiang University School of Medicine. Patients were randomized into two groups with 56 in each group: the control group received basic nutrition support; while the dietary fiber group were given additional dietary fiber ( total dietary fiber per day) before meals in addition to basic nutrition support. Intervention for all cases lasted for 8 weeks. Fasting blood glucose and postprandial blood glucose (2 h BG) were measured every week, and oral glucose tolerance test (OGTT) was performed at 42 d postpartum to evaluate the glycemic outcomes. Perinatal outcomes were recorded. The dietary fiber intervention markedly improved 2 h BG in patients with GDM and significantly elevated the glucose compliance rate from the 3rd to 8th week compared to the control group ( <0.05 or <0.01). OGTT 2 h glucose and the incidence of impaired glucose tolerance in the dietary fiber group were significantly lower than those in the control group, while the glucose compliance rate was significantly higher than that in the control group (all <0.01). Moreover, the rates of adverse perinatal outcomes, such as premature rupture of membranes and neonatal hyperbilirubinemia were declined in the dietary fiber group (<0.05 or <0.01). Dietary fiber intervention can ameliorate hyperglycemia in GDM patients, improve perinatal outcomes and reduce the incidence of postpartum impaired glucose tolerance.
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Female , Humans , Infant, Newborn , Pregnancy , Blood Glucose , Diabetes, Gestational , Dietary Fiber , Glucose Tolerance Test , Pregnancy OutcomeABSTRACT
Objective:To understand the current situation of clinical application and management of food for special medical purpose (FSMP) in China's medical institutions.Methods:A questionnaire was developed based on literature review, consultation with experts and multiple discussions to investigate the application and management of FSMP in hospitals. The survey was conducted in secondary and tertiary general or specialized hospitals in China. The accountable person of Clinical Nutrition Department in each hospital filled in the questionnaire with the guidance from provincial quality control center.Results:A total of 592 hospitals across 30 provinces/municipalities participated in the survey. The majority (40.5%) of prescription for FSMP with approved batch number was given by clinical nutrition departments, nutritional risk screening was conducted before using FSMP as enteral nutrition in 64.0% of the hospitals, consent from patients or their families prior to initial FSMP use was required in 94.8% of the hospitals, follow-up after FSMP use was carried out in 86.5% of the hospitals, 79.2% of the hospitals maintained electronic or paper documentation of the clinical application of enteral nutrition preparations, 41.6% of the hospitals had no organization or institution to supervise the standardized application of FSMP.Conclusion:In the future, we should strengthen the construction of FSMP professional team, establish convenient and efficient nutrition diagnosis and treatment information module, and set up special institutions to implement FSMP standardized management.
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Objective: To investigate the teaching effect of information teaching mode based on “ketangpai” network learning platform in teaching clinical nutrition and to provide guidance and method for information teaching. Method: By the random sampling method, 296 students from 2017 nursing undergraduate students of Wannan Medical College were selected and divided into two groups. The experimental group (n=148) was taught by information teaching mode based on "ketangpai" network learning platform. The control group (n=148) was taught by traditional teaching method. Both groups received the same teaching process，content and teacher. The experimental test, theory test and teaching effects were compared between the two groups. Results: The scores of experimental test and theory test in experimented group were significantly higher than those in control group (P<0.01). The abilities of self-learning, theory-practice, independent thinking, analysis, and knowledge mastery degree in experimental group were significantly better than those in control group (P<0.05). The students in the experimental group were more satisfied with the information teaching mode. Conclusion: Application of information teaching mode based on “ketangpai" network learning platform can improve the teaching effects, the students' comprehensive ability and self-learning ability.
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@#Background: Dietitians play a major role in health promotion and chronic diseases prevention. Graduates from clinical nutrition and dietetics major should be equipped with the necessary knowledge and skills for their role to be more effective. The purpose of this study is to investigate the knowledge and skills needed by current and future graduates in clinical nutrition and dietetics. Methods: In this qualitative study, structured interviews by focus groups were conducted. Dietitians from different governmental and private sectors were invited to participate in the study. Focus groups were stratified based on the participants’ gender and years of experience to promote self-disclosure. Abridged transcript of relevant and useful points was performed. The transcripts were coded and cross-validated by two researchers. Results: A total of four focus groups were conducted. Two focus groups comprise 9 male participants and the other two comprise 10 females. The age of participants ranged 25–40 years old. Participants were employees in Riyadh city with experience that ranged 3–10 years old. Nine themes of the necessary knowledge and skills were identified. Conclusion: It is recommended for the Saudi government to create standards specialised for clinical nutrition and dietetics undergraduate and graduate programmes.
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Huashan Hospital became the first Academic Medical Center Hospital accredited by Joint Commission International (JCI) in 2013. The Department of Clinical Nutrition has constantly improved internship education through the introduction of JCI standards. Based on the flexible combination of teaching and practicing modules, clinical nutrition knowledge is closely integrated with professional dietitian skills, and in-depth practical training helps students to acquire much more experience of the occupation as a dietitian. Teachers think highly of students' initiative and knowledge conversion ability, and in the recent five years, undergraduate projects have been enhanced in both quantity and quality.
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Huashan Hospital became the first Academic Medical Center Hospital accredited by Joint Commission International (JCI) in 2013. The Department of Clinical Nutrition has constantly improved internship education through the introduction of JCI standards. Based on the flexible combination of teaching and practicing modules, clinical nutrition knowledge is closely integrated with professional dietitian skills, and in-depth practical training helps students to acquire much more experience of the occupation as a dietitian. Teachers think highly of students' initiative and knowledge conversion ability, and in the recent five years, undergraduate projects have been enhanced in both quantity and quality.
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OBJECTIVE: To investigate the role of nutrition support pharmacists(NSP) in the clinical nutrition support. METHODS: By intervening the nutrition support schemes on a case of Wernicke encephalopathy occurred in the process of parenteral nutrition support, the role of NSP in the clinical nutrition support were investigated. RESULTS: NSP have proficient skill in nutrition risk screening and assessment, and may paticipate the whole process of evaluation to ascertain the patients' nutritionalstatus and whether the nutrition supports were needed. NSP were familiar with the complications of nutrition support therapy, and may alleviate the harmful impact to the patients or reduce the complications by the relevance evaluation and determination,and thus providing the solutions. NSP may educe their specialty and develop individualized nutrition support plan. CONCLUSION: The safety and effectiveness of clinical nutrition support can be improved by the participation of NSP.
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OBJECTIVE:To explore the role of clinical pharmacists in the clinical nutrition therapy for patients with parenteral nutrition-associated liver dagame (PNALD),and to promote the rational use of nutrition drugs. METHODS:Clinical pharmacists participated in the treatment of a case of PNALD,and suggested adjusting 5% Glucose and sodium chloride injection 500 mL to 0.9% Sodium chloride injection 500 mL,30% Long-chain triglycerides 250 mL to 20% Medium/long chain fatty emulsion 250 mL,8.5% Compound amino acid injection(18 AA)1000 mL to 8% Compound amino acid injection(15 AA)750 mL;addition-ally using 20%Alanyl glutamine injection 100 mL and 10% ω-3 Fish oil fat emulsion injection 100 mL inall in oneparenteral nutrition(PN)formula. The remaining recipes remain unchanged. Reduced glutathione and S-methionine were also adopted for pro-tecting liver and receding jaundice,and the amount of PN was decreased gradually and replaced by enteral nutrition (EN). RE-SULTS:Physicians adopted the suggestions of clinical pharmacists,and liver function of the patient recovered to normal. CON-CLUSIONS:Main factors of PNALD include medication time of PN,types and intake of lipid,over nutrition. Clinical pharmacists provide pharmaceutical care in nutritional treatment for patients,which can assure effective and safe use of nutritional drugs,and reduce the occurrence of complication and ADR.
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OBJECTIVE:To investigate the role of clinical pharmacists on parenteral nutrition support for liver cirrhosis patients with gastrointestinal bleeding.METHODS:Clinical pharmacists participated in parenteral nutrition support consultation for a liver cirrhosis patient with gastrointestinal bleeding.Based on etiology,liver function,complications and the effects of drugs on liver function,through two consultation,it was suggested to no longer add insulin into the patient's nutrient solution,adjust 20％ Fat emulsion injection(C14-24)250 mL to 20％ Medium-chain and long-chain fat emulsion injection (C8-24) 250 mL,adjust Compound amino acid injection(18AA-V)350 mL to 6 Amino acid injection(6AA)350 mL,adjust Calcium gluconate injection 1.0 g to 0.7g.Sodium glycerophosphate injection 10 mL and Alanyl glutamine for injection 10 g were added,decreasing dripping speed from 2 mL/min to 1.5 mL/min,increase Glucose injection (100 mL:50 g) from 300 mL to 350 mL.Blood glucose was also detected.RESULTS:Physicians adopted the suggestion of clinical pharmacists.The patient's condition and blood glucose control would keep stable till gastrointestinal bleeding was controlled,the diet returned to normal and none of above symptoms occurred again.CONCLUSIONS:The participation of clinical nutrition pharmacists in pharmaceutical care as parenteral nutrition support plays active role on the improvement of patients' nutritive condition and clinical prognosis improvement.
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This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. ‘Nutrition intervention’ was 4.5 ± 0.5 for task importance, ‘nutrition assessment’ was 4.0 ± 0.7 for performance, and ‘nutrition diagnosis’ was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were ‘checking basic information,’‘checking medical history and therapy plan,’‘decision of nutritional needs,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’ The tasks with high importance but low performance were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘monitoring of nutrition intervention process.’ The tasks of both high importance and high difficulty were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘supply of foods and nutrients,’‘education of nutrition and self-management,’ and ‘monitoring of nutrition intervention process.’ The tasks of both high performance and high difficulty were ‘documentation of nutrition assessment,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’
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Hospitals, General , Nutritionists , Tertiary Care CentersABSTRACT
PURPOSE: The purpose of this study was to explore whether or not there is a relationship between doctor's awareness of clinical nutrition service and needs for a clinical dietitian. METHODS: A cross-sectional survey design was used. The research was carried out by using questionnaires that had been specifically designed for the study. The research was conducted from September to October, 2013 for 311 doctors at 43 hospitals (with over 400 beds). Frequency analysis, factor analysis, reliability analysis, confirmatory factor analysis, and bootstrapping analysis were conducted using SPSS 21.0. RESULTS: ‘Implementation of clinical nutritional service’ (p < 0.001) and ‘usefulness on clinical nutrition service’ (p < 0.001) were found to be correlated with ‘importance of clinical nutrition service’ as an independent variable. The correlation between ‘importance of clinical nutrition service’ as a mediating variable and ‘needs for clinical dietitian’ as a dependent variable was also confirmed (p < 0.001). The results of the bootstrapping test showed that the mediating effect of ‘importance of clinical nutrition service’ was significant. The indirect effect value between ‘implementation of clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.040, indirect effect value between ‘usefulness on clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.095. CONCLUSION: The frequency of providing clinical nutritional services, the quality of clinical nutritional services, and the degree of implementation of clinical nutritional services were found to be important for positive perception of clinical nutrition services by doctors. Therefore, proper provision of clinical nutrition services and effective therapeutic effects will be continuously highlighted, which will increase the awareness of the physician and ultimately increase the demand for clinical nutrition service.
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Cross-Sectional Studies , Negotiating , Nutritionists , Therapeutic UsesABSTRACT
The purpose of this study was to analyze the importance-performance of clinical nutrition management in convalescent hospitals. The research was carried out based on questionnaires administered from March to April, 2015 to 73 dietitians at 40 convalescent hospitals in the Gyeongnam area. There was a statistically significant difference between the mean scores for importance (4.01/5.00) and performance (2.95/5.00) of clinical nutrition management. The importance and performance grid analysis showed that participation in a nutritional management committee, administration of patients using a cooperation program among hospital departments, cooperation with a medical team on patient's nutrition status, nutrition initial assessment, nutrition care process for patients showing malnutrition, nutrition care process for tube feeding patients, management of a therapeutic diet, meal management using dietary slip instructions including a therapeutic diet, and explication of a therapeutic diet for patients scored high regarding importance and performance (doing great area). Medical records on patient's nutrition management, and nutrition counseling for requested patient scored low regarding the importance and high regarding performance (overdone area). Participation in medical rounds, personal nutrition education for patients, group nutrition education for patients, nutrition education for medical teams, development of a menu for therapeutic diet and standardized recipes, and provision of information on diet therapy for patients after discharge scored low regarding importance and performance (low priority area). Accreditation of convalescent hospitals and interest of medical professionals in clinical nutrition management were effective variables for the importance-performance gap of clinical nutrition management. In conclusion, the accreditation process and positive awareness of medical professionals with regard to clinical nutrition management had positive effects on reduction of the importance-performance gap in clinical nutrition management at convalescent hospitals. The strength of clinical nutrition management in the accreditation and development of an education program for increasing medical team or administrator interest in clinical nutrition management could lead to improvement of clinical nutrition management for elderly patients in convalescent hospitals.
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Aged , Humans , Accreditation , Administrative Personnel , Counseling , Diet , Diet Therapy , Education , Enteral Nutrition , Hospital Departments , Hospitals, Convalescent , Malnutrition , Meals , Medical Records , Nutrition Assessment , Nutritional Status , NutritionistsABSTRACT
OBJECTIVES: The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians. METHODS: Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. The participating hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospital s and 223 dietitians completed the survey of clinical nutrition service s and job satisfaction questionnaires The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas. RESULTS: The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. KOIHA (Korea Institute for Healthcare Accreditation) accreditated hospitals showed only 50% performance rate of nutrition service evaluation area. This shows that after achieving KOIHA accredition, many hospitals do not emphasize the performance of nutritional services. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians. Linear regression analysis results showed that the "hospital adequacy grade" type was a significant predictor of job satisfaction level for two areas (working conditions & relationship). CONCLUSIONS: There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service s in long term care hospitals. Therefore, government and local hospitals have to work on implementing nutritional programs and policies for improved service and care.