"Health Focus"
Original title: What diseases do hospital nutrition clinics see and what are their uses?
People's Daily reporter Shen Shaotie
The 10th National Nutrition Week was held from May 12 to 18 this year. Various activities were held all over the country to popularize nutrition and health knowledge to the residents. The nutrition clinic of the hospital also ushered in a peak of medical treatment.
Nutrition treatment is an indispensable part of modern medical comprehensive treatment, and nutrition clinic plays a key role in patients' nutrition intervention. The National Nutrition Plan (2017-2030) proposed that "strengthen the construction of clinical nutrition departments", "increase multidisciplinary diagnosis and treatment models, establish nutrition support teams, and carry out nutrition treatment". In recent years, various places have continuously strengthened the construction of the clinical nutrition department of hospitals and set up nutrition clinics, which have been welcomed by the majority of patients. How about the operation of the nutrition clinic in the hospital? What kind of treatment can patients get? The reporter made a visit.
Customizing nutrition programs for patients
"The baby's weight grows slowly, so we should increase the amount of breast milk or milk powder feeding to maintain energy density." In the nutrition clinic of Beijing Children's Hospital affiliated to Capital Medical University, Feng Hui held her 3-month-old son and listened carefully to the doctor's advice. After measuring the baby's weight, the attending doctor Pan Changlu formulated a baby feeding plan for the young mother. "The baby's weight is too light. I used to be anxious, but now I know the reason. When I go back, I must adjust the feeding method according to the doctor's plan," said Feng Hui.
Liu Lingying (right), director of the nutrition department of the Fourth Medical Center of the PLA General Hospital, is receiving the doctor. Photographed by Shen Shaotie, a reporter of People's Daily
In a nutrition outpatient clinic located on the second floor of the outpatient building, weight measuring instruments, body composition analyzers, metabolic carts, grip strength devices, and various dietary models are placed in order, and a balanced diet chart for children and adolescents of different ages is posted on the wall. "These instruments are the standard configuration of our nutrition clinic, and they can be detected when children go to see a doctor, which is very convenient. The diet model placed can be almost confused, which is convenient for doctors to explain healthy diet knowledge to children." Yan Jie, director of the clinical nutrition department of Beijing Children's Hospital, said.
"The examination results show that your blood calcium content is low. While replenishing calcium, you should spend more time in the sun. Your hands and feet can be exposed, and you should pay attention to protecting your face." When Li Ying was filling in the dietary questionnaire, Liu Lingying, director of the nutrition department of the Fourth Medical Center of the PLA General Hospital, carefully advised. The evaluation results of the dietary questionnaire showed that Li Ying's eating was not scientific enough. Liu Lingying gave her a medical nutrition diet doctor's advice for medical nutrition treatment.
Li Ying, 61, who lives in Haidian District, Beijing, has suffered from chronic metabolic diseases such as hyperglycemia and hypertension for many years. "My illness is caused by a long-term unhealthy diet. When I went to see a doctor in other departments, the doctor said my lifestyle was wrong and recommended me to the nutrition clinic." Li Ying said that the nutrition clinic let her know how to improve her diet and better control her illness.
"In recent years, with the improvement of living standards, the proportion of overweight and obesity among Chinese residents is on the rise. Long term unhealthy lifestyle and unreasonable diet structure have led to a high incidence of nutrition related metabolic diseases such as diabetes, hypertension, hypercholesterolemia and so on. Professional guidance and treatment are urgently needed. Therefore, the demand of residents for nutrition clinics is also increasing." Analysis by Han Junhua, Secretary General and Researcher of Chinese Nutrition Society.
Since June 2022, the Hospital Management Research Institute of the National Health Commission has successively published the list of three batches of pilot units for clinical nutrition department construction. In March this year, the list was updated again. The number of hospitals on the list is increasing, and the pilot direction is gradually refined. After several years of development, clinical nutrition clinics in hospitals across the country are increasingly recognized by patients, and some hospitals have also opened Internet nutrition clinics.
"In the past two years, the growth of nutrition clinics has ranked first in the hospital, which objectively reflects the increase in patient demand." Yu Kang, director of the Clinical Nutrition Department of Peking Union Medical College Hospital, said that in 2020, the Clinical Nutrition Department of Peking Union Medical College Hospital opened an Internet clinic, and all doctors in the department were online. In 2023, the total number of nutrition clinics in the hospital will reach more than 61000 person times, of which the number of Internet clinics will be more than 16000 person times.
Featured outpatient service meets the diversified needs of patients
Yu Kang still clearly remembers the scene when anorexia patient Xiao Fang came to the hospital for treatment. "At that time, she was 19 years old, 1.67 meters tall and weighing only 34 kilograms, and she looked scrawny."
At the summer camp for weight loss held by Beijing Children's Hospital, the students exercised under the guidance of their instructors. Courtesy of Beijing Children's Hospital
Xiaofang's anorexia is more caused by psychological factors. At the beginning, when her classmates said that her face was fat, she began to lose weight. Even if she was very hungry, she would not eat for fear of getting fat. For a long time, he gradually lost his appetite. Anyone who persuaded her to eat, she thought it was a "bad person" who wanted to make her fat, including her family. Therefore, although he is a nutrition doctor, Yu Kang still needs to conduct psychological counseling for patients.
"Patients are very sensitive to the words' obesity 'and' fat meat '." Yu Kang said that doctors bypass these words and consider the reasons and needs for her weight loss from her perspective. Then she was given the knowledge of the relationship between muscle and nutrition. The doctor should let her know that the purpose of body nutrition supplement is not to become fat, but to improve immunity and muscle strength, so as to become more mature and beautiful.
After a period of treatment, Xiaofang gradually accepted the doctor's advice and began to increase her diet. In the meantime, she was also gluttonous, and even binge eating. In this regard, the doctor timely gave her psychological counseling and adjusted her diet. After a long period of treatment, Xiao Fang's weight increased to more than 40 kg, and finally exceeded 50 kg. All functions of her body returned to normal.
Many people do not understand the clinical nutrition department, and think that this department can only assist in treatment. Yu Kang said that in fact, the clinical nutrition department is irreplaceable. Patients received by other departments will always encounter nutrition problems. Doctors cannot solve all nutrition problems, but these problems can be well solved in the nutrition clinic. The clinical nutrition department is also a clinical department integrating medical treatment, scientific research and teaching. Its professionals are also composed of medical and nursing skills like other clinical departments. The difference is that on the basis of clinical medicine, nutrition professional background is also required. The clinical nutrition department uses nutrition intervention as a means to treat and prevent various diseases, such as weight management, eugenics, physical fitness, child growth and development, which are also the work scope of the nutrition department.
Yu Kang believes that the nutrition department of the hospital must take the road of combining with clinical practice, and create its own characteristics to meet the diversified needs of patients. He said that in 1996, Peking Union Medical College Hospital took the lead in opening nutrition clinics in China. Today, the clinical nutrition department has 12 doctors, 3 nutrition technicians and 7 statics nurses, covering nutrition management of almost all related diseases. According to the needs of patients, special outpatient clinics are set up, including pregnancy nutrition clinics, cancer nutrition clinics, weight management clinics, etc., to serve different populations.
"By attending the summer camp, I learned that obesity will lead to diabetes, fatty liver, hypertension and other diseases, and develop a healthy diet." Last July, at the opening ceremony of the summer camp for weight reduction in Beijing Children's Hospital, Xiao Wo, who has participated in the summer camp for two consecutive years, said in his speech. In the past year, Xiao Wo's height has increased by 10 cm, but his weight has not increased, and his figure has changed greatly.
Yan Jie introduced that the Clinical Nutrition Department of Beijing Children's Hospital has followed the comprehensive management model of "sports medical integration" for a long time, and has held eight consecutive summer camps for weight loss. The summer camp takes two weeks as a closed period. Overweight children will receive systematic course training, including weight loss nutrition knowledge, weight loss sports guidance, weight loss Chinese medicine guidance, weight loss psychological guidance, etc., all of which are taught by the experienced medical team of Beijing Children's Hospital, as well as professional sports team guidance, focusing on the development of children's daily habits. "For obese children, the nutrition clinic of Beijing Children's Hospital can carry out a series of assessments such as nutritional status and diet survey, family lifestyle, etc., and formulate personalized diet and exercise programs for children according to the assessment results."
Strengthen the training of clinical nutrition professionals
Health is the common pursuit of the people, and nutrition is one of the important contents to support health. In March 2022, the General Office of the National Health Commission issued the Guidelines for the Construction and Management of Clinical Nutrition Departments (Trial), requiring medical institutions that have established clinical nutrition departments to strengthen their construction and management, continuously improve their clinical nutrition diagnosis and treatment capabilities, encourage medical institutions that have not yet established clinical nutrition departments, and gradually establish standardized clinical nutrition departments. In recent years, great achievements have been made in the construction of the nutrition department of the hospital. The software and hardware facilities and the staffing team are constantly improved, and the quality of the nutrition clinic is significantly improved.
"The hospital should give great support to strengthen the clinical nutrition department and open a good nutrition clinic." Yu Kang said that in practice, some hospitals are also exploring to vigorously support the nutrition clinic in human, financial, material, space and other aspects, such as setting up a number of nutrition clinics in the specialized outpatient clinic, while providing enough outpatient units to ensure that the outpatient clinic can be available from Monday to Friday; The quiet therapy nursing team and nutrition nursing team of the hospital nursing system can cooperate with clinical nutrition doctors to complete nutrition support treatment. From a nationwide perspective, the development of nutrition department is still uneven. For example, some hospitals have poor clinical capacity of nutrition department and lack of specialists. Although nutrition clinics can be opened, the number of patients is not large.
How to solve this problem?
Talents are the key to improving ability. The reluctance of clinical medical talents to go to marginal departments such as the nutrition department is a common problem faced by major hospitals. Experts believe that this requires policy incentives and active guidance from the hospital.
Yu Kang said that Peking Union Medical College Hospital has made achievements in this regard. At present, the 12 doctors in the Clinical Nutrition Department of Peking Union Medical College Hospital are basically doctors and masters, and the new ones are all clinical postdoctors. Among them, 11 graduated from clinical medicine with rich clinical knowledge and can participate in multidisciplinary consultations in the hospital.
Clinical nutrition is an interdisciplinary subject, and selecting and training talents among clinicians is an important way to team building. In order to strengthen the training and education of clinical nutrition professionals, Yan Jie suggested that the training system should be improved, the clinical nutrition training system should be established, and the training courses should be optimized, so that doctors can grow into professionals who understand both clinical and nutrition. In addition, qualified medical colleges and universities are encouraged to add clinical nutrition related courses, strengthen the cultivation of nutrition related knowledge and ability of medical students, and lay a solid foundation for them to engage in clinical nutrition related work after graduation.
Yu Kang said that as early as 20 years ago, Peking Union Medical College Hospital began to participate in various forms of nutrition training courses. In terms of training at the doctor level, the trainees were not only the staff of the hospital, but also more students outside the hospital. "The Chinese Nutrition Society has been doing the training and grade evaluation of nutrition talents, and most of the certified and evaluated nutritionists are from hospitals." Han Junhua said that the clinical nutrition branch, tumor nutrition branch, diabetes nutrition branch and other branches of the Chinese Nutrition Society have strengthened cooperation with relevant branches of the Chinese Medical Doctor Association, and jointly trained doctors on clinical nutrition knowledge, Improve the nutritional intervention level of clinicians.
