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基于证据的脏营养实践指南的实施:AUGmeNt研究
Gabriela V Proaño1, Constantina Papoutsakis2, Lindsay Woodcock3
1PhD candidate, Florida International University; formerly Senior Research Project Manager, Academy of Nutrition and Dietetics.
概括
注册饮食营养学家 (RDNs) 显示了对蛋白质,和能量摄入的慢性病营养指南的高度遵守. 综合培训并没有显著改善护理的一致性,这表明需要更广泛的实施策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 临床营养学 临床营养学
- 医疗保健实施科学 医疗保健实施科学
背景情况:
- 临床实践指南 (CPG) 对于优化慢性病 (CKD) 中的营养护理至关重要.
- 通过注册营养师营养师 (RDNs) 评估CPG建议的实施,对于改善患者的治疗结果至关重要.
- 了解有针对性的培训对 RDN 实践的影响,是有效采用指南的关键.
研究的目的:
- 通过RDN评估RDN对已选定的CKD营养CPG建议的实施情况.
- 评估全面培训计划对RDN遵守CPG建议的影响.
- 分析 RDN 对准则可接受性,采用性和适应性的看法.
主要方法:
- 一个随机试验,比较标准的基于知识的培训与RDNs的全面实施培训.
- 评估 RDN 文档,以主观整体评估 (SGA) 和摄入蛋白质,能量,和口服营养补充剂 (ONS).
- 分析与CPG和RDN报告结果的护理一致性,使用多层次逻辑回归进行比较分析.
主要成果:
- 关于蛋白质 (100%), (95%) 和能量 (95%) 的摄入量,RDN记录实践和CPG建议之间的高度一致性.
- 对主观总体评估 (SGA) 组件 (体重/体重变化除外) 和口服营养补充剂 (ONS) 的相对一致性较低 (69%).
- 与标准培训相比,综合培训并没有显著改善与标准培训相匹配的护理机会;RDNs认为领导力支持是障碍.
结论:
- RDN实践与大多数精选的CKD营养CPG建议有很大的一致性.
- 综合性培训干预措施没有提高护理一致性,这表明仅培训方法的局限性.
- 涉及组织支持的多层次策略可能是改善CKD营养护理指南实施的必要条件.
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