Nutrition knowledge of physicians
Upcoming SlideShare
Loading in...5
×
 

Nutrition knowledge of physicians

on

  • 1,180 views

ASSESSMENT OF NUTRITION KNOWLEDGE OF PALESTINIAN PHYSICIANS EMPLOYED IN SHIFA HOSPITAL - GAZA CITY

ASSESSMENT OF NUTRITION KNOWLEDGE OF PALESTINIAN PHYSICIANS EMPLOYED IN SHIFA HOSPITAL - GAZA CITY

Statistics

Views

Total Views
1,180
Views on SlideShare
1,178
Embed Views
2

Actions

Likes
0
Downloads
6
Comments
0

1 Embed 2

http://www.docshut.com 2

Accessibility

Categories

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Nutrition knowledge of physicians Nutrition knowledge of physicians Presentation Transcript

  • ASSESSMENT OF NUTRITION KNOWLEDGE OF PALESTINIAN PHYSICIANS EMPLOYED IN SHIFA HOSPITAL - GAZA CITY By: Mohammad Subhi El-Lulu
  • Al-Azhar University of GazaDeanship of Postgraduate Studies and Research AffairsFaculty of PharmacyMaster Program of Clinical Nutrition Assessment of Nutrition Knowledge of Palestinian Physicians Employed in Shifa Hospital - Gaza City A small Project for Fulfillment of the Degree of Master of Clinical Nutrition By Mohammad Subhi El-Lulu Supervisor Dr. Jehad H. Elhissi Ass. Prof. of Public Health Health and Nutrition Consultant July- 2011
  • Dedication3 I would like to dedicate this work to the memory of my father “Subhi Salem El-Lulu”; to my mother; to my brothers and sisters particularly “Fawzi and Dr. Fathia”; to my wife and my lovely children “Omar, Lana, and Balsam” Faithful Mohammad View slide
  • 4 Contents  Introduction  Research Problem and Significance  Objectives  Methods and Subjects  Results  Conclusion  Recommendations  Selective References View slide
  • 5 Introduction
  • Introduction6  The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being, not merely the absence of disease and infirmity” (Blair, 2001).  “Nutrition is important for the maintenance of life, growth, reproduction, the functioning of organs and tissues, and the production of energy” (Webster-Gandy et al, 2008).  The role of nutrition in promotion, disease prevention and treatment of chronic disease is well recognized (Schaller & James, 2005).
  • Introduction7  Diet is now considered to play a substantial role in the etiology of many chronic degenerative diseases such as coronary heart disease, atherosclerosis, type-2 diabetes mellitus, osteoporosis, and some cancer types such as bowel, stomach, breast and prostate cancers (Turrell, 1997).
  • Knowledge Background8  Most individuals generally regard their physicians as the primary source of diet and nutritional information (Hu et al, 1997).  Survey studies revealed that physicians are hesitant to provide nutritional information to patients due to low levels of confidence resulting from a lack of education and knowledge in this field (National health promotion and disease prevention objectives, 2000).
  • Knowledge Background9  Physicians have the potential to decrease morbidity and mortality if they provide effective nutrition counseling and advice (Kushner, 1995).  Rogers (1983) identified three types of knowledge:  (1) awareness (such as diet- disease relationship),  (2) Knowledge of principles (e.g. cholesterol is found in animal foods only),  (3) how to knowledge (e.g. how to select foods with less fat or how to read a food label accurately).
  • Nutrition in medical education in Palestine10 Gaza Universities West Bank Universities 1) Al-Azhar University 1) An-Najah National provide two credit University provides a hours for general course of nutrition that principles of nutrition discusses the at college of medicine. relationship of diet and 2) Islamic University diseases. doesn’t provide a 2) Al-Quds University of course of nutrition Abu-Dis doesn’t within curriculum mention the academic plan. plan of curriculum.
  • Nutrition in higher education in Palestine11  Islamic University of Gaza provides Professional Diploma in Children Health and Nutrition “Just for Doctors” at college of Continuing Education.  Al-Azhar University of Gaza since 2006 has been a Master Degree of Clinical Nutrition (MDCN), and some of students in the program are doctors as many other medical fields.  That means: the nutrition become a new developing branch within medical education, which reveal the importance of nutrition to help and support medicine.
  • 12 Research Problem and Significance
  • Research Problem & Significance13  Five of the 10 current leading causes of death in United States (coronary artery disease, cancer, stroke, diabetes and atherosclerosis) are strongly linked with unhealthy dietary habits.  Also, diet contributes importantly to the risk for osteoporosis, obesity, hypertension and neural tube defects (Promoting health/ preventing disease, 1989).
  • Research Problem & Significance14  In 1990, the US Congress passed the National Nutrition Monitoring and Related Research Act, which mandated “that students enrolled in United States medical schools and physicians practicing in the United States have access to adequate training in the field of nutrition and its relationship to human health” (National Nutrition Monitoring and Related Research Act, 1990).
  • Objectives15 To identify the general nutrition knowledge of physicians working in Shifa hospital. To evaluate the concepts of patient’s nutritional assessment. To identify the role of physicians in nutrition education. To identify the knowledge of physicians regarding nutrition situation of hospitalized patients who are taking “total parenteral nutrition or enteral feeding”. To recommend the decision makers about the importance of nutrition in treating and preventing diseases.
  • 16 Methods and Subjects
  • Study design17  A descriptive cross-sectional design was used to determine nutritional knowledge. The study depends on reviewed questionnaire by associated professors working in academic and medical fields.  Dependent variable (knowledge of nutrition). Discusses the general principles of nutrition knowledge, as well as disease- nutrition relationship.  Independent variable (physicians): Age, Sex (male and female), Graduation (bachelor, master and MD), and Department.
  • Sample and sampling18  Sample size: Purposeful non probability sample was taken; the sample consists of 36 physicians.  Study setting and period The study was conducted in Shifa hospital in Gaza city, which is a large public hospital from March 2011 to July 2011.  Target population All physicians who are working at Shifa hospital (Surgical and Obstetric) departments.
  • Ethical consideration19  Approval letters from Deanship of Pharmacy.  Approval and permission letter from General Administration of Human Resource Development (the main department at Ministry of health for scientific researches).  Approval signature from the head of department.  Informed consent from participated physicians.
  • Eligibility criteria20 Inclusion criteria Exclusion criteria  Male and female  Trainees and (Job physicians currently Creation Program) employed in the physicians hospital.
  • Data collection21 • 1st part composed of physician’s personal characteristics. • 2nd part explains training and practice. Questionnaire • 3rd ask about knowledge of principles of nutrition. • 4th awareness of diet- disease relationship 4 Parts • 12 completed questionnaires from obstetrics and gynecology department. Criterion of • 24 completed questionnaires from surgical department. Distribution
  • Study analysis22 SPSS Coding Entry Cleaning Analysis
  • 23 Results
  • 1 st part: Age of participants24 Less than 35 years No. 6 16.7% From 35 to 45 years No. 20 55.5% More than 45 years No. 10 27.8% Total No. 36 100%
  • 1st part: Physicians sex distribution25 Male No. 29 80.6% Female No. 7 19.4% Total N0. 36 100%
  • 1st part: Graduation degree of physicians26 Bachelor No. 12 33.3% Master No. 19 52.8% PhD No. 5 13.9% Total No. 36 100%
  • 1st part: Departments of physicians27 Surgery No. 24 66.7% Gynecology and Obstetrics No. 12 33.3% Total N0. 36 100%
  • 2nd: Studying the nutritional therapy in school of medicine28 • 27 out of 36 Yes • 75% • 9 out of 36 No • 25% • Intensive Course If Yes (7.4%) • Just Required Course (92.6%)
  • 2nd: Courses of nutritional therapy at hospital29 Yes 12 24 33.3% 66.7% NO
  • 2nd: Can nutrition knowledge help and develop practical medicine30 • 35 out of 36 Yes • 97.2% • (suggest the place) at next slide • 1 out of 36 No • Without reasons
  • 2nd: The best place for teaching the nutrition therapy31 At Continued At Medicine Medical school Education 10 25 28.6% 71.4%
  • 2nd: Importance to have nutrition department at hospital32 33 Yes (91.7%) 3 No (8.3%)
  • 33 Part 3 of Questionnaire Knowledge of Principles Knowledge of Nutrition Assessment
  • Nutrition Principles (Questions) No. (%)Stearic acid is essential fatty acid as linoleic acidYes 15 (41.7%)No* 6 (16.6%)I don’t know 15 (41.7%)Leptin hormone is important forHunger 11 (30.6%)Satiety* 6 (16.6%)I don’t know 19 (52.8%)Peripheral Parenteral Nutrition can lead to thrombosisYes* 23 (63.9%)No 10 (27.8%)I don’t know 3 (8.3%)Central Venous Feeding is safe from infectionsYes 9 (25%)No* 24 (66.7%)I don’t know 3 (8.3%)34
  • Nutrition Principles (Questions) No. (%)To avoid aspiration, Enteral tube should be inserted intoStomach 27 (75%)Duodenum* 5 (13.9%)I don’t know 4 (11.1%)Clear Liquid Diet such as Plain Gelatin can provide calories forfew daysYes* 11 (30.6%)No 6 (16.6%)I don’t know 19 (52.8%)Mechanical Soft Diet can’t be used for whom suffer from difficultyof chewing or swallowingYes 9 (25%)No* 9 (25%)I don’t know 18 (50%)35
  • Assessment (Questions) No. (%)Body Mass Index (BMI) = Weight in (kg)/Height in (cm)²Yes 21 (58.4%)No* 7 (19.4%)I don’t know 8 (22.2%)An important parameter act with BMI to assess obesity for maleWaist/hip ratio* 4 (11.1%)Hip/waist ratio 5 (13.9%)I don’t know 27 (75%)Do you know Subjective Global Assessment (SGA)?Yes 8 (22.2%)No 28 (77.8%)If the answer is Yes SGA could be adapted to predict postsurgical nutritionassociated morbidities:Yes* 7 (87.5%)No 0 (-%)I don’t know 1 (12.5%)36
  • Assessment (Questions) No. (%)Do you know Instant Nutritional Assessment (INA)?Yes 8 (22.2%)No 28 (77.8%)If the answer is Yes INA adapted for nutritional assessment of preoperativepatients: 4 (50%)Yes* 4 (50%)No 0 (-%)I don’t knowDo you know Nutrition Risk Index (NRI)?Yes 10 (27.8%)No 26 (72.2%)If the answer is Yes It can’t be used as an index of malnutrition in hospitalizedpatients:Yes 3 (30%)No* 6 (60%)I don’t know 1 (10%)37
  • 38 Part 4 of Questionnaire Awareness of diet- disease relationship
  • Diet - disease relationship (Questions) No. (%)Excessive homocysteine level in blood associated withCancer 11 (30.6%)Heart disease* 5 (13.9%)I don’t know 20 (55.5%)Which of the following in excessive amount is Tertogenic?Vitamin A* 15 (41.7%)Vitamin K 5 (13.9%)I don’t know 16 (44.4%)In presence of renal stone of Calcium Oxalate, we have to reducethe intake ofSodium* 5 (13.9%)Calcium 25 (69.4%)I don’t know 6 (16.7%)Extra-abdominal fat level can be associated with breast cancer infemaleYes* 13 (36.1%)No 12 (33.3%)I don’t know 11 (30.6%)39
  • Diet - disease relationship (Questions) No. (%)Anti-thrombotic nutrient isVitamin E 10 (27.7%)Omega 3* 15 (41.7%)I don’t know 11 (30.6%)A type of fibers help lowering cholesterol level in bloodSoluble* 12 (33.3%)In-Soluble 14 (38.9%)I don’t know 10 (27.8%)Disadvantages of Total Parenteral Nutrition (TPN) are Gall Stonesand CholestasisYes* 20 (55.6%)No 8 (22.2%)I don’t know 8 (22.2%)A nutrient prevents Neural Tube DefectFolate* 20 (55.6%)Cyanocoblamin 5 (13.9%)I don’t know 11 (30.5%)40
  • Diet - disease relationship (Questions) No. (%)Daily requirement of fluids for normal adult is 2.5 ml/kcal of bodyweightYes 9 (25%)No* 9 (25%)I don’t know 18 (50%)Healthy adults require at least 50 Kcal/kg of body weightYes 13 (36.1%)No* 6 (16.7%)I don’t know 17 (47.2%)Basal Metabolic Rate is the minimum energy required to maintainnormal physiological function during exerciseYes 15 (41.7%)No* 10 (27.8%)I don’t know 11 (30.5%)Do you know Refeeding Syndrome?Yes 7 (19.4%)No 29 (80.6%)41
  • 42 Conclusion
  • Mean of grades of physicians knowledge (general principles and nutrition assessment)43 Mean 3.11 SD: ±2.05 Minimum Maximum score: 0/12 score: 9/12
  • Mean of grades of physicians knowledge about awareness of diet- disease relationship44 Mean 3.66 SD: ±2.04 Minimum Maximum score: 0/12 score: 9/12
  • Mean of Total Score No (%)45 6.77 Mean (28.23%) SD: ±3.22 Minimum Maximum Score Score 1/24 (4.16%) 13/24 (54.16%)
  • Relationship between age of participant physicians and their percentage of nutrition knowledge46 Percentage of knowledge Age Less than 20% 20% - 40% More than 40% No. (%) No. (%) No. (%) Less than 35 2 (33.3%) 2 (33.3%) 2 (33.3%) 35 – 45 5 (25%) 11 (55%) 4 (20%) More than 45 1 (10%) 8 (80%) 1 (10%) The result shows that: less age / more knowledge
  • Relationship between age of participant physicians and their percentage of nutrition knowledge47 (0.460) Pearson Chi- Square Value Not Statistically Significant
  • Relationship between percentage of knowledge and participants department48 Percentage of knowledge Departments Less than 20% 20% - 40% More than 40% No. (%) No. (%) No. (%) Surgery 5 (20.8%) 17 (70.8%) 2 (8.3%) Obstetrics 3 (25%) 4 (33.3%) 5 (41.7%) The result shows that: Physicians of obstetric department have higher and more knowledge than physicians of surgery department
  • Relationship between percentage of knowledge and participants department49 Statistically Significant Pearson Chi- Square Value (0.038)
  • 50 Recommendations
  • Nutrition department at hospital is important request, because it helps in clinical assessment, diet management, & status follow-up. Physicians should take courses about basic and essentials of nutrition, to get a proper understanding of nutrition. School of medicines should have adequate course about nutrition. Good training and practice at hospital through continued medical education. Physicians should take intensive course of nutrition therapy according to their specialty.51
  • Selective References52  Blair S., (2001). Clinical exercise physiology for cancer, cardiovascular and pulmonary rehabilitation. Exercise Physiology. (Eds. McArdle W.D., Katch F.I., Katch V.L.). Fifth Edition. Lippinocott Williams and Wilkins. Philadelphia. PP: 912- 965.  Hu S.P., Wu M.Y. and Liu J.F., (1997). Nutrition knowledge, attitude and practice among primary care physicians in Taiwan. J. Am. College Nutr. 16: 439- 442.  Kushner R.F., (1995). Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Preventive Medicine. 24: 546- 552.  National health promotion and disease prevention objectives, (2000).US Department of Health and Human Services. Office of disease prevention and health promotion, healthy people 2010. US Public Health Service. Washington, DC. Government Printing Office.
  • Selective References53  National Nutrition Monitoring and Related Research Act of 1990, (1990). Public Law. 101- 445.  Promoting health/ preventing disease: year 2000 objectives for the nation, (1989). US Department of Health and Human Services. Washington, DC: US Government Printing Office.  Rogers E.M., (1983). Diffusion of Innovations. New York: Free Press.  Schaller C. and James E., (2005). The nutritional knowledge of Australian nurses. Nurse education today. Australia. 25: 405- 412.  Turrell G., (1997). Department of gender differences in dietary behavior. Nutr. Res. 17: 1105- 1120.  Webster-Gandy J., Madden A. and Holdsworth M., (2008). Oxford Handbook of Nutrition and Dietetics. Oxford. Oxford Medical Publications.
  • Al-Azhar University of GazaDeanship of Postgraduate Studies and Research AffairsFaculty of PharmacyMaster Program of Clinical Nutrition Assessment of Nutrition Knowledge of Palestinian Physicians Employed in Shifa Hospital - Gaza City A small Project for Fulfillment of the Degree of Master of Clinical Nutrition By Mohammad Subhi El-Lulu Supervisor Dr. Jehad H. Elhissi Ass. Prof. of Public Health Health and Nutrition Consultant July- 2011