Nutrition Diagnosis Etiology Matrix.pdf |BEST|
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The Nutrition Diagnosis, identifies the specific nutrition problem that the dietitian is responsible for treating and works towards resolving. The nutrition diagnosis uses specific terminology from the eNCP. There are 3 classifications of the nutrition diagnosis: Intake, clinical, and behavioral.
Intake: these diagnosis relate to intake and nutrition related problems (oral, enteral and parenteral nutrition). Intake diagnosis cover the areas including energy balance, fluid intake, bioactive substances and nutrient intake.
Clinical: these diagnosis include medical or physical conditions that have a nutritional impact. The clinical category covers the areas of functional changes or impairments, biochemical changes (altered ability to metabolize nutrients) and weight.
Diagnosis should be specific to the role of dietitians. Behavioral-Environmental related Nutrition Diagnosis often fit better as the etiology (E) (the cause of the nutrition problem), and not the Nutrition Diagnosis itself. Remember the aim of your Nutrition Intervention is to resolve (ideally) the Nutrition Diagnosis.
Individuals with HIV are at higher risk for developing prediabetes and diabetes on antiretroviral (ARV) therapies, so a screening protocol is recommended (89). The A1C test may underestimate glycemia in people with HIV; it is not recommended for diagnosis and may present challenges for monitoring (24). In those with prediabetes, weight loss through healthy nutrition and physical activity may reduce the progression toward diabetes. Among patients with HIV and diabetes, preventive health care using an approach used in patients without HIV is critical to reduce the risks of microvascular and macrovascular complications. Diabetes risk is increased with certain PIs and NRTIs. New-onset diabetes is estimated to occur in more than 5% of patients infected with HIV on PIs, whereas more than 15% may have prediabetes (90). PIs are associated with insulin resistance and may also lead to apoptosis of pancreatic β-cells. NRTIs also affect fat distribution (both lipohypertrophy and lipoatrophy), which is associated with insulin resistance. For patients with HIV and ARV-associated hyperglycemia, it may be appropriate to consider discontinuing the problematic ARV agents if safe and effective alternatives are available (91). Before making ARV substitutions, carefully consider the possible effect on HIV virological control and the potential adverse effects of new ARV agents. In some cases, antihyperglycemic agents may still be necessary.
We used a standardized neurobehavioral assessment scale to determine patients' level of consciousness: the Coma Recovery Scale-Revised (CRS-R) . The CRS-R assesses auditory, visual, verbal and motor functions as well as communication and arousal level. The total score ranges between 0 (worst) and 23 (best). The CRS-R has shown superior performance in detecting VS and MCS compared to other scales [12, 16, 17]. Post-comatose patients were assessed once with the CRS-R by experienced raters (CS or AV). Relying on the Aspen criteria , we operationalized the definitions of VS, MCS and emergence from MCS using the items on the scale that were designed for this purpose. CRS-R-derived diagnostic criteria are mentioned in Table 1. We compared the diagnosis derived from the CRS-R assessments performed by the research team (CS or AV) to the clinical consensus diagnosis. The clinical consensus diagnosis was based on daily behavioral observations and included observations made within the last 24 hours by a clinical team comprised of physicians, psychologists, speech therapists, occupational therapists, physiotherapists and nurses. The research team was not involved in the clinical consensus diagnoses. The physicians recorded the clinical consensus diagnosis according to the observations reported by each member of the clinical team during structured but also unstructured team meetings and, in all cases, communicated this diagnosis to the research team prior to conducting the CRS-R assessment. The research team was hence not masked to the clinical consensus diagnoses. When all the clinical staff agreed, diagnosis was deemed VS or MCS. When even one person disagreed, the diagnosis was deemed 'uncertain'. Patients thought to have emerged from MCS based on consensus diagnosis were not assessed on the CRS-R. All patients were assessed once by the research team and were assigned a diagnosis of VS, MCS or emerged from MCS. Differences in diagnosis relative to length of time post-injury (acute vs. chronic) and etiology (traumatic vs. non-traumatic) were assessed using Chi square test, thresholded for significance at p < 0.05. The study was approved by the Ethics Committee of the University of Liège. Informed consent was obtained from each patient's legal surrogate. 2b1af7f3a8