Computer applications in nutrition and dietetics: an annotated bibliography 9781315057538, 1315057530, 0-8240-6621-9, 978-0-8240-6621-5

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COMPUTER APPLICATIONS IN NU TRITION AND DIETETICS

GARLAND REFERENCE LIBRA RY OF SOCIAL SCIENCE (Vol. 428)

COM PUTER APPLICATIONS IN N U T R I T I O N AND DIETETICS A n Annotated Bibliography

John Orta, Ed.D., R.D.

First published 1988 by Garland Publishing, Inc. Published 20 17 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business © 1988 John Orta

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Orta, John, 1947Computer Applications in Nutrition and Dietetics: An Annotated Bibliography I John Orta. p. cm.-(Garland Reference Library of Social Science; vol. 428) Includes indexes. ISBN 0-8240-6621-9 (alk. paper) 1. Nutrition-Data processing-Bibliography. 2. Food serviceData processing-Bibliography. 3. Diet-Data processingBibliography. I. Title. II. Series. Ill. Series: Garland Reference Library of Social Science: v. 428. Z5776.N8077 1988 [TX357] 016.6132'028'5-dc 19 87-30450 CIP

ISBN 13:978-0-8240-6621-5 (hbk)

I dedicate this book to my beautiful and loving wife Amy and to my ever-inspiring son Jason

CONTENTS Preface

ix

Acknowledgments

xiii

CHAPTER I.

NORMAL NUTRITION

Introduction

3 CHAPTER II.

CLINICAL NUTRITION

Introduction General References Assessment of Nutritional Status of Individuals Nutritional Management of Disease Drug-Nutrient Interactions Modifications of the Normal Diet Patient Management and Counseling CHAPTER III.

11 12 14 34 36 37 41

COMMUNITY NUTRITION

Introduction

51 CHAPTER IV.

MANAGEMENT

Introduction Management Functions Labor/Management Relations Management Information Systems General References Computer Applications Nutrient Analysis Systems and Data Bases Software Selection CHAPTER V.

53 53 59 61 61 73 82 95

FOOD SERVICE OPERATIONS

Introduction General References Menu Planning

99 99 104

vii

viii

Contents

Receiving and Storage Production and Processing Layout and Design

113 113 117

CHAPTER VI. COMPUTER-BASED EDUCATION IN NUTRITION AND DIETETICS Introduction General References Normal Nutrition Clinical Nutrition Management Food Service Operations Food Science General Public Higher Education Professional Test-Items Banks

119 119 121 128 137 141 143 148 152 166 168 INDEXES

Glossary Author Index Title Index Subject Index Journals Outline of Contents Covering Major Areas of Dietetics and Nutrition

171 189 195 203 225 227

PREFACE

Over the past three decades there have been significant advances in the role of computers in nutrition and dietetics. Despite numerous published articles and theses, very few books devoted to the subject exist. Furthermore, the disci­ pline covers so much ground that it is difficult to keep up with the relentless evolution of computers in all facets of the foods and nutrition professions. Scholars and practitioners in the field are currently engaged in efforts to integrate computer technology into their professional endeavors. A major obstacle in the pur­ suit of this goal is the absence of comprehensive compila­ tions of published materials on the subject. Another diffi­ culty is associated with gathering relevant information on particular computer applications related to specific areas of the discipline. This is a time-consuming if not difficult task for the busy professional. This book is designed for those wanting to become acquainted and up-to-date with the progress of computer technology in the foods and nutri­ tion professions over the past three decades. A selective yet representative sample of published mate­ rials related to computer applications in nutrition and die­ tetics are summarized in this book. Five questions need to be addressed so that the reader can make optimal use of this text and understand how it is organized. These are (1) What is the scope of the book? (2) How were the materials se­ lected? (3) How are the bibliographic entries annotated? (4) How is each bibliographic citation annotated? and (5) How can the reader find specific references efficiently? Scope of the Book This work covers the literature published between 1958 and 1987 related to computer applications in nutrition and die­ tetics. The majority of the citations are from professional journals. Relatively few are from trade periodicals. The

iX

X

Preface

list of journals from which the citations were obtained is found on page 225. Several bibliographic entries include chapters from books in the discipline. They are cited be­ cause of their unique perspective on the subject. Although many theses and dissertations have been published related to computer applications in the discipline, these are covered from published reports as they appeared in the professional literature. However, two dissertations are annotated be­ cause of their timeliness. Only a few books, on limited aspects of the subject, have been published. Their contents are summarized in the appropriate section. How the Materials Were Selected As the author worked on his doctoral dissertation (item 190) he collected numerous .articles related to computer ap­ plications in the foods and nutrition professions. Aware of the increasing importance of the role of computers in the discipline, coupled with a realization of the absence of a single-reference source on the subject, the author decided to summarize each of the references which he collected with an eye towards compiling an annotated bibliography. This work is a by-product of those efforts. The author owns a copy of each of the items cited. Consequently, each citation was personally selected, inspected, studied, summarized and eval­ uated by the author. In line with the objectives of this book, the citations were selected from a broad range of topics concerned with the disciplines of human nutrition and dietetics. The criteria for the selection of each citation was contingent on their ability to contribute to a better understanding of the role of computers in the discipline. Based on the number and diversity of topics addressed, the reader will find a repre­ sentative distillation of the literature related to the evolution of computer applications in nutrition and dietetics over the past three decades. Organization and Classification of the Bibliographic Entries The book is divided into six chapters which parallels the major areas of study in the typical American under­ graduate dietetics and nutrition curriculum. These areas are normal nutrition, clinical nutrition, community nutrition, management, food service operations, and food science. A meta area encompassing computer-based education was added to these topics in order to include the literature on educational

Preface

xi

applications of computers relative to the concerns of the discipline. Since most nutrition professionals in the United States study these common areas in order to meet the minimum educational requirements specified by the American Dietetic Association, it was reasoned that organizing the book along these lines would include the common body of knowledge that nutritionists possess. The American Dietetic Association has developed an out­ line of the areas covered by the Registration Examination for Dietitians. An adaptation of this outline was used to clas­ sify each bibliographic entry. The complete outline begins on page 227. Once classified, each annotation is presented alphabetically by author. Every effort was made to classify each article according to the outline. However, many citations deal with more than one subject. Therefore, each reference was classified on the basis of its predominant theme. Inevitably, there may be cases where a citation may appear to belong in another section of the book. Here the author weighed carefully where to place overlapping references. In order to compensate for any deficiency associated with the classification of a refer­ ence, the reader is referred to either the title or the com­ prehensive subject index. How Each Bibliographic Citation is Annotated Each entry was carefully reviewed, thoroughly summarized, and in many instances critically appraised. Comments con­ cerning the potential implications of some citations are included. Notwithstanding, every reference is sufficiently summarized to enable the reader to become acquainted with its contents and decide whether it is worth acquiring the fulltext of the citation. How to Find Specific References To facilitate the search for a specific topic or topics, the reader may search the subject index, the author index, and the title index. If the reader is looking for works by a specific author or authors then referral to the author index is indicated. If a search is to begin with several topics in mind, the reader is referred to the thorough sub­ ject index which includes over a thousand entries. The complete title index permits the reader to select articles on the basis of their titles.

xii

Preface

Finally, two additional features which the reader may find helpful include cross-referencing and the glossary. Related entries are cross-referenced so that germane topics may be pursued in greater depth. Unfortunately, the study of computer applications in nutrition and dietetics is re­ plete with jargon. This led to the decision to include a glossary which is designed to assist the reader by defining uncommon terms. In sum, efery effort was made to be faithful to the main objective of the book, namely, to enable the reader to become acquainted and up-to-date with the evolution of com­ puter applications in nutrition and dietetics. If any por­ tion of this work contributes to advance the integration of computers into the discipline and results in the subsequent betterment of human health, then it succeeds beyond the author’s original intent.

John Orta September 16, 1987

ACKNOWLEDGMENTS

This book found inspiration in the pioneering work of my friend and adviser, Dr. Winthrop R. Adkins, Professor of Psychology and Education at Teachers College Columbia Uni­ versity. I would also like to express my gratitude to Ms. Priscilla Crombie who patiently typed and retyped the com­ plete manuscript. I am also grateful to Jack Raso for his fine work in editing portions of the manuscript. Finally, I am thankful to Ms. Phyllis Korper, Editor from Garland, who cheerfully answered all my questions and made the writ­ ing of this book a real pleasure.

xi i

Computer Applications in Nutrition and Dietetics

CHAPTER I NORMAL NUTRITION

INTRODUCTION

Nutrition is the study of food relative to human health. Normal nutrition encompasses the study of human energy needs and nutrient requirements, physical and chemical properties, functions, utilization, food sources, recommended allowances and the results of nutrient deficiencies on the human organism. Additional areas of study in normal nutrition include body composition, dietary guides and their applications, meal patterns and food habits, and nutritional needs throughout the life cycle.

1.

Balintfy, Joseph, L., and Lilly M. Lancaster. "Computing ’Best Fit’ Calorie-Controlled Diet Patterns by Microcomputer." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (January 1987): 71-73. Calculation of meal patterns using the exchange list method is adaptable to computerization. The general problem is to determine the number of exchanges from each exchange group in order to derive a meal pattern that satisfies prescribed nutritional goals. There are many meal patterns that may meet a given set of nutritional goals. However, the problem is not fully defined unless a criterion is available to choose one out of several nutritionally adequate meal patterns. An early attempt at computing "best fit" diets is described in item 42.

3

4

Normal Nutrition The authors identified "desired pattern" as the criteria. This led to the problem of finding the "best fit" to the desired meal pattern that satisfies nu­ trient goals. Motivated by the work of Suitor et al. cited in item 46 the authors approached the problem mathematically and computationally. They wrote and described a BASIC microcomputer program for the IBM Personal Computer designed to find diet patterns that "best fit" individually desired nutritional constraints.

2.

Caster, W.O. "Use of a Digital Computer in the Study of Eating Habit Patterns." AMERICAN JOURNAL OF CLINICAL NUTRITION 10 (February 1962): 98-106. Among the most valuable information that a nutri­ tionist can possess is knowledge of the factors that affect food consumption. One of the earliest published reports on the use of digital computers in nutrition dealt with the study of eating habits. An ambitious attempt was made to use computers in a study designed to sort out the multiple variables impacting on food consumption patterns among individuals and groups. It was reasoned that with the aid of modern digital com­ puters the time was ripe to conduct studies on food consumption records more detailed than had previously been practical. The speed and ease with which statis­ tical results could be obtained were cited as advan­ tages of using computers. Caster concluded that available statistical meth­ ods, with the aid of computers, could be applied to large volumes of data about the usual food consumption patterns of a group of individuals. From processing such data, a fairly accurate picture of the eating patterns of different persons within the group could be derived. Such techniques would allow identifica­ tion of individuals whose eating patterns deviate in a significant way, and direct attention to the extent of such differences. Additionally, such procedures suggest ways to plan and interpret dietary survey data.

Introduction 3.

5

Cleveland, Linda E., and Andrea B. Pfeffer. "Planning Diets to Meet the National Research Council’s Guidelines for Reducing Cancer Risk." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (February 1987): 162-168. A computerized quadratic programming model was used to develop diets for American adults meeting the criteria set by the Recommended Dietary Allowances (RDAs) and the National Research Council's interim guidelines for reducing cancer risk. The potential impact of such dietary changes on nutrient levels and costs were analyzed. Diets were planned using data from the United States Department of Agriculture’s 1977-1978 Nationwide Food Consumption Survey and a computerized model that minimized deviations from average consumption patterns while meeting the RDAs. The computer model permitted an appraisal of the effect of modifying variables to fit specified constraints.

4.

Foytik, Jerry. "Very Low-Cost Nutritious Diet Plans Designed by Linear Programming." JOURNAL OF NUTRITION EDUCATION 13 (June 1981): 63-66. Foytik used linear programming, a mathematical technique for breaking problems down into a form amenable to computer solution, to determine its usefulness in designing low-cost nutritionally adequate dietary guidelines. These were intended for low-income groups and others wishing to cut their household food expenses to a level below that of the United States Department of Agriculture's Thrifty Food Plan. The author assumed that some consumers would be willing to change their eating patterns in order to consume nutritious, low-cost foods. However, people do not select foods on the basis of discrete attributes such as cost or nutrition. They think of foods holistically. It is naive to assume that a number of variables programmed into a computer will generate a consumable diet plan. This item is contested in item 10.

6

5.

Normal Nutrition Hayes, Olive B., Sidney Abraham, and Cesar A. Caceres. "Computers in Epidemiologic Dietary Studies." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 44 (June 1964): 456-460. These workers argued for the use of computers in epidemiologic studies when working with exceptionally large volumes of data, requiring lengthy and repetitive data processing, involving complex statistics or extensive classification, and speed for data analysis. Hayes and colleagues observed that using computers in epidemiologic studies of cardiovascular disease provided three advantages, including (a) improved data comparability, (b) easier adaptation of innovative approaches to the analysis of dietary data, and (c) greater efficiency of data storage for future use. These workers concluded that the computer was a useful new tool available for epidemiologic dietary research.

6.

Katch, F.I., and V.L. Katch. "Computer Technology to Evaluate Body Composition, Nutrition, Exercise." PREVENTIVE MEDICINE 12 (1983): 619-631. Researchers used computers to evaluate body composition, nutrition and exercise. They devised a computerized system called, FITCOM (an acronym for fitness by computer). It evolved from a need to provide a rapid system of data analysis for various professional sports teams and world-class athletes. The system generated reports related to body composition, meal plans, and exercise programs. Its practicality stemmed from its capacity to be used interactively to plan menus and exercises based on individual preferences. Heretofore, the norm was to plan menus and exercises first and then proceed to follow the plan. Also, FITCOM obviated the need to perform the tedious manual calculations required to individualize an exercise and nutrition plan. FITCOM's interactive computer-based technology was valuable because of its thoroughness and speed. For example, an individualized 16-page report considering such factors as body composition, body size, sex, age, activity preference, and current fitness levels could be generated in ten seconds.

Introduction

7

The authors concluded that such reports could greatly enhance the quality of health services.

7.

Pao, Eleanor M . , and Marguerite C. Burk. "A ComputerAssisted Approach to Meal Patterning." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 65 (August 1974): 144-150. The United States Department of Agriculture periodically conducts food consumption surveys. It would be helpful if researchers who undertake such studies had methods that would facilitate the job. These investigators were involved in research to organize and code food combinations into meal patterns. They reported on a computer-assisted approach to meal classification based on combinations of foods and the application of a meal patterning scheme to dietary data obtained from a 1965 survey of groups from two regions of the United States— North Central and South. The approach made extensive use of computer programs. It accomplished the following: (a) grouped foods within meal patterns, (b) combined these components into meal patterns, and (c) coded the patterns. These researchers suggested that their work was useful to nutritionists and dietitians because meal patterning data could be used to investigate relationships between variables such as (a) food intake, meal frequency, and obesity; (b) food intake, fat and heart disease; and (c) food intake, additives, and toxicity. Pao and Burk stated that further research along these lines were under way. It involved developing procedures to relate single meal patterns to (a) the day's food patterns, (b) the socioeconomic characteristics of the individuals’ studied, and (c) the day's nutrient intake pattern.

8.

Sawicki, Marjorie, and Jeannette Endres. "Energy and Nutrient Calculations Using an Optical Character Reader System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (February 1983): 135-141. A new application of the Optical Character Reader (OCR) technology in dietetics was used to tabulate dietary data, and to calculate energy and nutrient

8

Normal Nutrition values from dietary records. The authors analyzed 30 one-day dietary records. They employed three different procedures: manual, online computerized, and the new OCR technology. A comparison was made of the results of the tabulations, length of time to execute the tasks, and costs. No significant difference was found in the results of the calculations among the three methods used to determine energy and nutrient values. There was, however, a significant difference in the time required to calculate dietary records. The most time-consuming was the hand calculations, followed by the online computerized method, and the OCR method. Similarly, there was a significant difference in terms of costs, the manual method being the most costly. The cost of the manual method was found to be twice that of the online method and four times the cost of the OCR method. Although the OCR technology yielded reproducible results, obviated the need for in-house computer facilities, and outperformed the two alternative methods in terms of time and costs, this system required that the dietary records be sent to a central facility for processing. The turnaround time to obtain the results was 7 to 10 days. Obviously this would reduce the utility and the timeliness of a dietary evaluation, which is often needed immediately to provide effective patient counseling. Notwithstanding, the technology showed great potential for other applications in nutrition.

9.

Thompson, Ethel M., and Henry Tucker. "Computers in Dietary Studies." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 40 (April 1962): 308-312. It was reasoned that time and costs were limiting factors in the number of diets that could be evaluated by conventional methods, that is, using pencil-andpaper procedures and desktop calculators. They reported that the arrival of low-cost, high-speed computing simplified the process of calculating the nutritive values of diets. Additionally, they speculated that computing capabilities could be extended to furnish simultaneous information, along

Introduction

9

with the results of the dietary analyses, at minimal additional cost. Such information would include factors that impact on dietary selection including nutritional recommendations, food cost data, personal income, and occupation. These researchers also theorized that eventually computers could simultaneously consider other variables like palatability, digestibility, and evaluation of nutrition status as a function of a changing diet. Thompson and Tucker reported that the limiting factor in the use of computers in many areas was the relatively high initial cost of preparing data processing (input) cards. Nonetheless, these researchers were optimistic that advances in the use of computers would greatly accelerate development of new techniques with which to measure human health.

Woteki, C.E. "Low-Cost Nutritious Diet Plans— A Commen­ tary." JOURNAL OF NUTRITION EDUCATION 13 (June 1981):

66 . Woteki rebutted Foytik’s linear programming model (item 4) arguing that a more promising route seemed to be interactive computing systems. In such a system, the person who would ultimately use the diet plan would input the data and include palatability constraints. That is, the household food manager would select those constraints that constitute the minimum essentials of an acceptable diet plan. In this fashion, a diet plan could be individualized to address the needs and food preferences of the house­ hold. There is an important lesson in all of this. First, Foytik viewed the problem from an agricultural economics perspective. In terms of generating acceptable diet plans, it takes more than just de­ limitation of a few constraints, linear programming, and a computer: it requires a knowledge base encom­ passing the many complex determinants of human food selection. Secondly, planning an eating strategy using interactive computing systems is more likely to be successful when constraints include not only nutrition and cost factors, but palatability factors as well, that is, including nutritious foods that are

10

Normal Nutrition widely acceptable across all segments of the popula­ tion. To accomplish this requires greater input by those familiar with the factors that affect eating patterns, nutrition, and computing capabilities. This implies that nutritionists should become more conversant with computing in order to execute their work more effectively and professionally.

CHAPTER II CLINICAL NUTRITION

INTRODUCTION

Clinical or therapeutic nutrition deals with dietary modifications to fit the needs of individuals with pathological conditions. The area of study encompasses first, assessment of the nutritional status of individuals through the collection of dietary information, appraisal of physical findings, and laboratory measurements; and second, the comprehensive nutritional management of diseases arising from abnormal conditions with nutritional implications, including disorders of all major bodily systems. Modifications of the normal diet often requires changes in the consistency of the diet, the frequency and amount of food allowed, and nutrient levels. Moreover, a major concern in the nutritional management of diseases is the potential for adverse drug-nutrient interactions. Such may involve the effects of drugs on nutrient absorpiton and metabolism, and/or the effects of foods on drug absorption and utilization. Additionally, proper nutritional care in disease requires careful patient management and counseling. Effective interviewing, development of individualized diet plans, adaptation of counseling to the patients' lifestyles and needs, documentation in the |medical records, follow-up, and evaluation of the nutritional care plans are the hallmarks of effective nutritional care. The third major area involved in clinical nutrition is the nutritional support of the critically ill patient, which entails the technology of alternative feeding modalities, including tube and parenteral feedings. Finally, the fourth area of study in clinical nutrition is quality assurance and peer review

11

12

Clinical Nutrition

of the professional performance of nutritionists and dietitians in accordance with pre-established guidelines for the nutritional management of patients afflicted with various diseases.

GENERAL REFERENCES

11.

Bell, Louise. "Computer Applications in Clinical Dietetics in Canada: Why Should We Recreate the Wheel?" JOURNAL OF DIETETIC SOFTWARE 1 (Summer 1984): 3, 4, 6. Computer applications for the calculation of nutrient intakes are relatively few in Canada as compared to the United States. Therefore, Canadian nutrition professionals are in a position to study and evaluate the problems that the more technologically advanced American nutritionists have faced in developing computer applications in clinical dietetics. Past unsuccessful efforts by Canadian workers included development of computerized models which were not transferable because of hardware incompatibility from one brand to another. Technology has advanced to minimize such problems today. In 1980 Agriculture Canada undertook an assessment of nutrient data bases which led to the development of the Canadian Nutrient File. It will be the basis for the data banks to be used in Canadian public health programs, dietary surveys, research studies, teaching and clinical dietetics. Limitations of the system are: (a) nutrient files lack many foods, and (b) many special foods used in clinical dietetics are excluded. One of the major advantages cited for establishing a central nutrient file system is that it would allow professionals access to comprehensive and reliable nutrient data without duplication of efforts associated with creating individual data banks. Notwithstanding, differences between the data bases in various nations, their reliability, and features were discussed as elements to examine when

General References

13

considering establishing a Canadian national nutrient data file.

Danford, Darla E. "Computer Applications in Clinical Nutrition." NORMAL AND THERAPEUTIC NUTRITION. 17th ed. Chapter 44. Robinson, Corrine, Marilyn R. Lawler, Wanda L. Chenoweth, and Ann E. Garwick. New York: Macmillan, 1986, 612-620. Students of nutrition, dietetics and other health workers are urged to learn to integrate computer applications into their practice in order to enhance their professional performance. Danford reviews computer applications in clinical nutrition focusing primarily on their use in nutritional assessment and nutrition education. This is significant because, along with item 12, this chapter is part of a trend to include a textbook chapter on computer applications in the relevant branch of the discipline. In this case clinical nutrition. Computer use in nutritional assessment delineated are: (a) anthropometric and body composition measurements, (b) clinical assessment, (c) biochemical assessment, and (d) dietary assessment. Moreover, computer applications related to diet counseling, interview techniques, planning nutritional care, bedside monitoring, charting and follow-up, research, and home health care are presented. Different aspects of computer-assisted instruction in the discipline are described. These encompass elementary to college education, dietetic internships, and consumer education. Predictions are made about the future of computers in the discipline along with a word of caution on the potential misuse of the technology.

Williams, Sue R. "Computers in the Management of -Nutritional Practice." NUTRITION AND DIET THERAPY. 5th ed. Chapter 31. St. Louis, Missouri. Times Mirror/Mosby College Publishing, 1985, 821-840. Current computer applications in nutrition practice are introduced in this chapter of a popular

14

Clinical Nutrition nutrition and dietetics textbook. It initiated a trend followed by other publishers (item 11) to enlighten nutrition students on the implications of the computer revolution to their profession. Human factor issues such as general user anxiety, professional resistance, patient/client response are discussed. Technical issues such as computer system development, and applications in the field are introduced. These include (a) clinical care in the hospital setting, (b) nutritional assessment and support services, (c) nutrition analysis, (d) nutritional therapy and care plans, (e) business management of clinical practice, (f) nutrition counseling, (g) nutrition surveys, (h) programplanning, (i) nutrition education at all levels, and (j) nutrition research. The chapter includes a mini-glossary which defines important computer terms. It also features a section designed to assist readers on how to select home diet/exercise software.

ASSESSMENT OF NUTRITIONAL STATUS OF INDIVIDUALS

14.

Brisbane, Helen M. "Computing Menu Nutrients by Data Processing." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 44 (June 1964): 453-455. Innovative procedures for calculating menu nutrients using computers and data processing techniques are described by a consulting dietitian with the Veterans Administration Data Processing Center in Los Angeles. She described a study of 28 Veterans Administration Hospitals that used computers experimentally to calculate the nutritive value of their menus. The study showed that computers provided dietitians with more accurate calculations and a greater speed than manual methods. The author concluded that it was possible to calculate the nutritive value of diets with automatic data processing equipment. Two limitations were expressed, however: first, that all data processing for the Western Veterans Hospitals studied was done

Assessment of Nutritional Status

15

centrally in Los Angeles by a single computer; second, that the initial tasks for setting up an effective system were found to be time-consuming. Nevertheless, once the system was in place it could be used indefinitely. Brisbane proposed that diets of individual patients could be analyzed by computers in response to doctors' orders or to identify nutrition education needs.

15.

Buckley, Donald C., Kenneth A. Kudsk, Barry S. Rose, et al. "Anthropometric and Computerized Tomographic Measurements of Lower Extremity Lean Body Mass." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (February 1987): 196-199. Anthropometry is a standardized technique used to determine the effect of nutritional therapy on muscle mass. Anthropometric procedures are also commonly used to assess the loss of lean muscle mass and to diagnose the extent of protein-calorie malnutrition. However, anthropometric measurements do not accurately reflect actual limb composition when compared to computerized tomography. Twenty lower extremities of randomly selected men and women were evaluated by anthropometry and computerized tomography. Anthropometric procedures overestimated total and muscle plus bone crosssectional area at almost every level. The authors concluded that while anthropometry is easily performed and useful in large population groups for epidemiological studies, it yields a poor assessment of lower extremity composition. On the other hand, computerized tomography is also easily performed, offers an accurate assessment of lower extremity tissue compartments, yet it is impractical for use in large population groups. Application of computerized tomographic scanning to research on body composition is relatively new yet it can provide valuable information that is unavailable by other techniques.

16.

Bunton, Peggy W. "Using the Computer as a Referral Source to Find the Patient at Nutritional Risk." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 86

Clinical Nutrition (September 1986):

1232-1233.

A hospital developed a computerized system to assist in the identification of patients at risk nutritionally. It consisted of a computer retrieval program that yielded a "nutritional risk list" organized by patient name, age, room number, diet prescription, and length of time the patient was on the diet. Two major benefits resulted from the implementation of the system. First, a larger number of patients could be assessed nutritionally than was possible with conventional methods. This increased the efficiency and effectiveness of the dietitian. Second, the increased visibility resulting from the computerized procedures promoted a heightened awareness of the dietitians' expertise, thus promoting the status of the profession.

17.

Dare, Doris, and Susan Yarbrough Al-Bander. "A Computerized Diet Analysis System for the Research Nutritionist." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 87 (May 1987): 629-632. Research nutritionists should consider several factors before selecting a computerized diet analysis system. Among these are (a) the data base, (b) ease of use, (c) format of the printout, (d) flexible programming to accommodate design of research diets, (e) costs, and (f) efficiency brought about by computerization. An interactive diet analysis system is described that fits the criteria specified by the authors who are research nutritionists. The nutrient data base is accurate, verified, and updated periodically. Data entry is easy. New foods and recipes can be added to the data base. The system offers features that allow for efficient creation and analysis of complex research diets in order to analyze nutrient intakes and report nutrient data.

18.

Dennis, Barbara, Nancy Ernst, Marthana Hjortland, Jeanne Tillotson, and V. Grambsch. "The NHLBI Nutrition

Assessment of Nutritional Status

17

Data System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 77 (December 1980): 641-647. The National Heart, Lung, and Blood Institute developed a computerized dietary collection system for conducting large-scale research studies involving nutrition components. The system was standardized and was especially useful in identifying and quantifying different dietary fats. The authors explained that these same features could be adapted to meet the nutritional demands of other epidemiological studies. Other useful features of the system included centralized training, certification, and other quality control procedures which made possible uniform dietary data collection procedures. Validation studies demonstrated that variance of data collected by trained interviewers was not significant. . This meant that simultaneous gathering of dietary data over a large geographical area by field teams was possible. This report demonstrated the computer’s ability to measure the impact of changes in the complexity of the food supply on public health.

Evans, Sue N., and Annette Gormican. "The Computer in Retrieving Dietary History Data. 1. Designing and Developing a Computerized Diabetic Dietary History." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 63 (October 1973): 397-402. Researchers from the Department of Nutrition at Harvard University and Beth Israel Hospital’s Nutrition Clinic in Boston, recognizing the importance of a meaningful diet history as a prerequisite for formulating an appropriate meal plan for patients with diabetes mellitus, designed, developed, and tested a computerized methodology to obtain diabetic diet histories. They used a small, economical, high-speed digital computer available for medical research at the University of Wisconsin Center for Health Sciences in Madison. The machine was called Laboratory Instrument Computer (LINC). It consisted of an oscilloscope (today called a monitor) which projected pre-programmed questions on the screen for patients

18

Clinical Nutrition to respond to. A keyboard was used for input of responses. The output was generated by a teletypewriter in the form of a printout. LINC had been extensively used in the past by a variety of medical specialties for medical interviews. Therefore, Evans and Gormican were, in fact, adapting a computerized interviewing methodology which had a successful history. Expansion of this work is described in item 24. The computerized methodology for obtaining diet histories was tested with fifty diabetic patients. Information obtained from the automated interviews were judged adequate for developing an individualized dietary plan for subsequent use by the patient. The majority of those who participated in the computerized interviews found them to be an interesting and enjoyable experience. Variables, such as age and educational level, did not greatly affect the length of time to complete the automated interview. However, previous experience with the computer keyboard, good eyesight, and typing ability shortened the time. Evans and Gormican's computerized diabetic diet history interview program recorded and stored patients' responses on magnetic tape. A system was therefore needed to organize the information obtained from the dietitian.

20.

Flook, Marion G., of Systems for Calculation." ASSOCIATION 64

and Betty V. Alford. "Cost Comparison Nutrient Analysis— Computer vs. Manual JOURNAL OF THE AMERICAN DIETETIC (January 1974): 62-64.

The cost of dietitian-calculated versus computerized nutritional analyses were compared. A procedure was developed to document the time required to calculate the nutritive value of the house diets at Parkland Memorial Hospital in Dallas. The researchers found that costs were significantly less for computerized calculations than for the dietitian's manual analyses. It was also concluded that the computer relieved the dietitian of repetitive clerical tasks, allowing more time for professional activities related to patient care.

Assessment of Nutritional Status 21.

19

Frank, G.C., R.P. Farris, and G.S. Berenson. ’’Comparison of Dietary Intake by Two Computerized Analysis Systems." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 84 (July 1984): 818-820. Two nutrient data bases were used to analyze eight 24-hour recalls from a 50% random sample of 10-year old students participating in a cardiovascular survey in Louisiana. Despite the small number of diets analyzed the group means of selected nutrients were quite similar except for sucrose. The authors conceded that a larger sample could have created a statistically significant difference due to a large calculated standard error for most components. It was recommended that periodic comparability checks were essential to document the quality and soundness of computerized nutrient data bases.

22.

Gerace, Terence, A. "The Descriptive Sales Slip: A Dietary Assessment Tool on the Horizon." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 86 (April 1986): 515-516. The descriptive sales slip (DSS) can be a useful innovative adjunct to currently used dietary assessment techniques. The DSS is the printed list of foods provided by supermarket check-out equipment that reads printed UPC codes on each purchase. It was reasoned that since people generally eat the foods they purchase, dietary assessments from DSS appear logical. Ten arguments are presented for considering the use of DSSs in assessing diets. These include: 1.

DSSs provide baseline data which enables a nutritionist to easily identify foods that are inappropriate for a patient on a prescribed diet.

2.

DSSs highlight foods that patients should "avoid," yet are purchased for household consumption.

3.

DSSs may be used as long-term, selfmonitoring devices obviating the need

20

Clinical Nutrition for maintaining food diaries. 4.

DSSs may be used to reinforce new behaviors when reduced cost is used as an extrinsic motivation.

5.

DSSs may be useful in large intervention trials in which whole communities are targeted for dietary change.

6.

DSSs can help patients recall snack items.

7.

DSSs supply brand names which patients may not be able to recall.

8.

Portion sizes may be better estimated.

9.

The representativeness of single 24-hour dietary recall can be appraised.

10.

DSSs can improve the accuracy of food frequency questionnaires.

Limitations associated with the use of DSSs in assessing diets are: (a) they provide insufficient information on who eats what in the household, (b) difficulty in estimating the size of typical portions and, (c) limited comprehensiveness because people consume foods from sources where DSSs are unavailable.

23.

Hertzler, Ann A., and Loretta W. Hoover. "Development of Food Tables and Use with Computers." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 70 (January 1977): 20-31. Reasoning that computer technology was rapidly emerging and that it had facilitated the analysis of large amounts of data for many nutrients, the authors summarized the history of American food composition tables. Their aim was to provide an historical background and promote a better understanding of the content and use of this tool. They developed a resource that nutritionists could refer to in the design or selection of a computerized nutrient data base. In their paper the authors described 27

Assessment of Nutritional Status

21

selected tables of food composition and data bases developed between 1895 and 1977. Moreover, they described limitations of food tables and the development of computer-stored nutrient data bases. The authors explained that over the years food composition tables varied in their classification schemes, the number of food items, and the number of nutrients they contained. Similarly, computerized nutrient data bases were found to vary in the same ways as printed food composition tables. Hertzler and Hoover reported on the development of computerassisted diagnostic procedures to detect and edit inconsistencies in nutritional data input into computerized data bases. In sum, the authors predicted that in the future computerized nutritional data would become more reliable, comprehensive, and suitable for various uses.

24.

Hjortland, Marthana C., William G. Duddleson, Carol Porter, and Arthur B. French. "Using the Computer to Calculate Nutrients in Metabolic Diets." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 49 (November 1966): 316-318. A three-year experience using modern digital computers to calculate dietary components is described. A program to relieve the monotonous and time-consuming tasks of dietetic research was designed by the staff of the Clinical Research Unit of the University of Michigan Medical Center. These tasks involved the extraction of many items from food composition tables, followed by numerous arithmetic calculations. Hjortland et al. found the computer to be a useful and effective tool to calculate nutrients and plan research diets. These researchers found that, in addition to being adaptable whenever food tables would be modified, the computer saved substantial time for the dietitian. These workers suggested that similar techniques could be adapted by any dietetic department having access to a computer center and a staff to develop the programs.

22 25.

Clinical Nutrition Hsu, N. and A. Gormican. "The Computer in Retrieving Dietary History Data. II. Retrieving Information by Summary Generation." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 63 (October 1973): 402-407. The authors developed a "summary generation program," using the LINC system discussed in item 18. It was designed to generate a printout with various types of information based on the responses from the computerized interviews. This included food preferences and typical food intake. Such information would enable a dietitian to evaluate a patient’s food habits, their understanding of diabetes mellitus, and other factors relevant in planning diet instructions. The system was tested with 24 diabetics in several hospitals in Madison, Wisconsin. Refinements were made following a professional peer evaluation. The final product was a legible and standardized summary of a patient’s dietary, medical, and social history. Both patients and professionals took interest and approved of the summary forms. Hsu and Gormican concluded that such computer-generated records could be a significant aid to physicians and dietitians in identifying special problem areas.

26.

Hunt, Isabelle F., Larry S. Luke, Norma J. Murphy, Virginia A. Clark, et al. "Nutrient Estimates from Computerized Questionnaires vs. 24-hr. Recall Interviews." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 74 (June 1979): 656-659. Following published reports describing the use of computers to interview subjects and determine diet histories in order to effectively counsel patients, these investigators researched whether data on nutrient intake derived from a computerized questionnaire agreed with estimates obtained from 24-hour recalls taken during one-to-one interviews. The study was conducted by Hunt and fellow researchers at the School of Public Health and Dentistry, University of California, Los Angeles. Because of increased recognition of the role of diet in the etiology of dental caries, many dentists offer nutritional counseling. The starting point in

Assessment of Nutritional Status

23

the counseling process is a detailed diet history. In California, a number of dentists have used dietary questionnaires, designed to be completed by patients in their waiting room, to elicit nutritional histories. A company in the business of computerized analysis of diets developed a food frequency questionnaire that was thought to be useful in eliciting dietary information from dental patients. Following its completion by the patient, the questionnaires were sent to the company and processed by computer. The results were provided in the form of quantitative estimates of the patient's nutrient intake. Recommendations were included in the printout on the use of vitamin and mineral supplements. Questionnaires were processed at a cost of $5.00 each and mailed to the dentists for review. Hunt and colleagues compared the reported nutrient intakes of 46 dental patients obtained from the computerized food frequency questionnaires with the average of five 24-hour, one-to-one dietary recalls from the same patients. The researchers found that the two techniques yielded similar estimates of carbohydrates and caloric intake. However, data from other nutrients varied from 6 to 88 per cent. Moreover, the researchers warned that the computerized dietary assessment service included unwarranted recommendations for supplementation of vitamins and minerals. They advised dentists to critically evaluate the recommendations of computerized nutritional analysis services in light of these findings. Clearly there were computer-wise individuals in the late 1970s marketing more than computerized analysis of diets. It took a critical review of the situation by members of the profession to articulate the need for a cautious approach to adopting similar computer applications. The Southern California Dental Association, which supported the study in part, must have recognized the value of effective procedural guidelines for selecting and adopting computerized nutritional assessment protocols.

24

Clinical Nutrition The work of Hunt and colleagues confirmed the need to effectively educate clinical nutrition personnel to recognize the limitations and critically evaluate the output of computer-generated nutritional analyses. The wide variation in the results obtained from manual versus computerized calculations suggested that computer-generated output should be carefully scrutinized.

27.

Johnson, Nancy E., Christopher T. Sempos, P.J. Elmer, et al. "Development of a Dietary Intake Monitoring System for Nursing Homes." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 80 (June 1982): 549-557. Researchers from the University of WisconsinMadison reasoned that microcomputers and programmable calculators could be useful in making rapid dietary assessments. A limiting factor, however, was the memory capacity of these computing devices. One way to overcome this obstacle was to reduce the number of foods and nutrients in the working data base in order to conform to the memory capacity of the computing device chosen. At the same time foods in the data base had to be representative of those most commonly consumed by the population under study. Following a review of the literature of several past attempts by dietetic professionals to develop a rapid, inexpensive, yet reasonably accurate method of dietary analysis to replace weighing or chemical analyses of foods, these researchers described a series of steps to develop a dietary assessment system. The five major steps included (a) setting the specific objectives of the monitoring system, (b) determining the foods that would constitute a "core" diet, (c) constructing a precoded record form, (d) developing a food composition data base, and (e) writing the computer program. After implementing these steps and applying the monitoring system in a nursing home study, the researchers found that daily food intakes could be estimated with less than 10% error. The authors concluded that either programmable calculators or microcomputers with limited memory capacity may be programmed to calculate several dietary parameters

Assessment of Nutritional Status

25

using from 125 to 250 core foods as part of the data base. Such assessment programs could be designed to allow nonprofessionals to input the data rapidly and to yield an output in the desired format. Portable systems, such as the one described, will enable dietary assessments to be conducted accurately and rapidly anywhere at any time. Thus, these computing devices will facilitate immediate identification of potential dietary problems which would indicate expedient nutritional intervention and lead to a healthful and timely resolution.

28.

McLaurin, Nancy K., Cleon W. Goodwin, Claudia A. Zitzka, and Edwin W. Hander. "Computer-Generated Graphic Evaluation of Nutritional Status in Critically Injured Patients." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (January 1983): 49-52. Researchers from the United States Army Institute of Surgical Research nutrition support service at Fort Sam Houston, Texas, described the development of a continuous computer graphic evaluation program. It was designed to assist in the quick and efficient evaluation of the nutritional status of critically ill patients, eliminating the need to read and calculate long lists of chart entries. The system was used with critically ill burned patients. Summary graphs of stored information on the nutritional status of patients could be generated on demand. These yielded a complete listing of calories and specific nutrients ingested by patients, including protein, fats, carbohydrates, most vitamins, and most minerals. The display also noted the route of nutrient administration, namely, oral, nasogastric, or intravenous. Additionally, the percentage of predicted requirements consumed, nitrogen balance, calorie-to-nitrogen ratio, and percentage of weight change were displayed. Once the graphs are generated, they were displayed at the bedside of each patient for review. They were valuable since they showed the patient, his family, and staff his progress or lack of it. Both medical and nutritional progress may be accelerated with the assistance of a dietitian, who may be instrumental

26

Clinical Nutrition in highlighting the role of nutrition in the rehabilitation of patients with traumatic injuries. The graphic display of the patient’s daily nutritional status offers a number of positive advantages. For one, it alerts the health care team to lapses in the patient’s nutritional status. Second, it facilitates evaluation of the effectiveness of protein and other nutrient supplements to meet nutritional goals. In sum, the display of the graphs at bedside served as a perpetual reminder of the importance of nutritional support in the rehabilitation of critically ill patients. Such an application requires immediate dissemination in order to benefit many.

29.

Mo, Amy, Penelope S. Peckos, and Carlton B. Glatky. ’’Computers in a Dietary Study." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 59 (August 1971): 111-115. A methodology was developed for computer analysis of the nutritional information component of a longitudinal study involving 150 pairs of twins. The objective of the study was to obtain an accurate estimate of somatic growth of twins and access the contribution of genetic and environmental influences, including nutrition, to growth pattern, growth rate, and physique relative to chronologic and physiologic age. Input of food intake and food composition data into the main computer program consisted of coded cards. The composition cards had values for 19 nutrients per 100-gram portion for 28 food groups. An edit program was developed to check for the occurrence and correction of several types of possible errors. Mo et al. suggested that parts of the main program used in this study could be useful to hospitals, health care institutions, and the nutrition research departments of colleges and universities. They suggested that, with additional programming, the program could be extended for use in systems involving the production and evaluation of therapeutic diets, or food purchasing and food cost accounting. To

Assessment of Nutritional Status

21

avoid the installation of costly computer facilities, the authors suggested a time-sharing configuration whereby a number of institutions could use the same program via a teletype console, installed in each inst itut ion.

30.

Pasulka, Patrick, Stacey J. Bell, Marianne Galvin, George L. Blackburn. "Computer Software for Nutrition Support Services: Needs Analysis and Product Assessment." TOPICS IN CLINICAL NUTRITION 1 (October 1986): 28-35. Six functions that a computer software package might fulfill for a nutrition support service are:

1.

nutritional assessment and prescript ion

2.

flow sheet of serial data,

3.

consultation function,

4.

administrative function,

5.

clinical research and data storage, and

6.

teaching.

Although there is a role for computer software in nutrition support services, existing packages vary significantly. Therefore, it is essential that nutritionists understand the scope and limitations of the software they plan to purchase.

31.

Schaum, K.D., M. Mason, and J. Sharp. "Patient-Oriented Dietetic Information System. 2. Compiling a Computerized Nutrient Data Bank." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 63 (July 1973): 39-41. The Ohio State researchers reasoned that existing data processing technology and computer availability also made it feasible to calculate the nutritive values of foods by computer. An essential component of nutritional analysis calculations, whether they be manual or computerized, is extensive food composition data. Based on these considerations the

28

Clinical Nutrition Ohio researchers set out to compile an extensive nutrient data bank. They stored the figures on punched cards, a disk file, and magnetic tape. The data bank was designed to have a miximum capacity of 10,000 food items and 63 nutrients. Each food was encoded in 100-gram edible portions. All nutrient data was systematically collected to ensure accuracy and recency. It took about two years to design, compile, and store the data. The researchers conceded that despite having many gaps, the file was one of the most comprehensive available at that time. The system also allowed for updates and expansion of data. The researchers described work in progress on enhancements to the system, including programs to calculate menus, recipes, and nutrient intake analysis. Finally, plans called for the nutrient data bank to become a reference source available to the Ohio area in several formats: (a) hard-copy, (b) punched cards or magnetic tape, (c) terminal access via telephone link-up, (d) use of the University’s Hospital computer system for analyzing recipes, menus, or food consumption records.

32.

Sorenson, Ann W . , Bonita W. Wyse, Arthur J. Wittwer, and R. Gaurth Hansen. "An Index of Nutritional Quality for a Balanced Diet." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 68 (March 1976): 236-242. Researchers from the Department of Nutrition and Food Sciences at Utah State University, Logan developed a new concept called the Index of Nutritional Quality (INQ). Its purpose was to evaluate and improve the nutritional quality of diets. It was a tool that could be used to carry out computerized qualitative and quantitative analyses of foods, recipes, and menus. In addition, the tool was found useful in planning clinical diets, in determining nutritional trends, and as a vehicle for nutrition education. Results of INQ calculations were displayed in an easy-to-understand computergenerated format. The INQ idea was based on the nutrient density concept, that is, a comparison between the nutritive

Assessment of Nutritional Status

29

content of a quantity of food and its energy (caloric) content relative to human requirement for the individual nutrients and energy. Mathematically, the relationship was expressed as follows. INQ=

Amount of nutrient in portion that meets energy needs Human requirement for that nutrient Using INQs, a food or a meal may be scrutinized for its nutritional value. A computer program was developed to calculate the INQs. It produced a printout of the results displaying the INQs in a tabular and graphic format. The authors argued that INQs had many potential clinical, as well as educational, applications in food science and nutrition. In a word, the INQs quantitatively evaluated nutrient composition of foods in relation to their caloric value. Since the concept had been computerized, the authors reasoned that each parameter could be expanded or modified to fit various purposes. For example, the composition of a food could be compared with recommended standards for consumption and with the INQ ratio printout in graphic form. The standard INQ format provided a quick means of depicting food composition while retaining quantitative information essential for professional use. Graphic representations made possible the rapid comparison of individual foods and diets by displaying their INQ. The authors further argued that a graph depicting eight nutrients plus energy was satisfactory for general dietary purposes. Nonetheless, the system was designed to be expandable. That is, other nutrients could be included if it became necessary for a given food or diet evaluation. The authors agreed that a computer's ability to store, retrieve, and update nutritional data enhanced the INQ concept's usefulness in nutritional studies. In 1979 a more comprehensive book, entitled NUTRITIONAL QUALITY INDEX OF FOODS was published. It extended the INQ concept to include, among other topics, the nutritional quality of snack foods, nutrition labeling, and international nutrition

30

Clinical Nutrition examined with the aid of INQs. In sum, it was con­ cluded that INQ computerized techniques permitted rapid assessment of nutritional quality, replacing cumbersome hand calculations.

33.

Watt, Bernice T., Susan E. Gebhardt, Elizabeth W. Murphy, and Ritva R. Butrum. "Food Composition Tables for the 1970s." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 64 (March 1974): 257-261. By the mid 1970s there was great interest in the nutritive values of foods. It emanated from the general public concern about health and nutrition and the new laws governing nutrition labeling of processed foods. Such laws stimulated interest on the part of the food industry to conduct chemical analyses to determine the nutritive values of foods. In order to handle the anticipated expansion in the amount of nutritional data that would be generated, the United States Department of Agriculture (USDA) initiated plans to establish a computerized Nutrient Data Bank (NDB). The Nutrient Data Bank was designed to serve as an international depository for nutritive value in­ formation. It would be submitted by agricultural experiment stations, industry, literature searches, and government contracts and grants. Foreign data would be accepted as well. The idea was to bring to a central place data gathered on nutrient values of foods, including beverages and ingredients. Data on all nutrients, whether they were recommended, or considered essential but not recommended, would be provided. The NDB established a system for (a) handling food composition data on a greatly increased level; (b) faster input of data and related information, particularly from the food industry; and (c) com­ puterized input and retrieval of data. It was an­ ticipated that once the system was operational, the NDB information would be readily available to primary users, including food scientists, nutritionists, dietitians, and other groups whether they be in pro­ fessional, academic, or industrial communities.

Assessment of Nutritional Status

31

Watt et al. (1974) described the steps involved in establishing the nutrient data bank. These included (a) the preparation of the data collection form, (b) the development of a classification system with which to categorize food items, and (c) pinpointing particular problem areas for further research. Once the NDB would be established, other needs were anticipated, such as the review of data received, clarification of questions about the analytical data, and writing computer programs to handle the data.

34.

Witschi, Julia, Holly Kowaloff, Saul Bloom, and Warner Slack. "Analysis of Dietary Data: An Interactive Computer Method for Storage and Retrieval." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 78 (June 1981): 609-613. Investigators from the Department of Nutrition, Harvard University, School of Public Health hypothesized that computerized nutritional data storage and retrieval systems were capable of aiding nutritionists in the diagnosis of eating problems and subsequent planning and implementation of corrective diets with their patients. Notwithstanding, the progress which had been made with both accuracy and the speed of arithmetical manipulation of dietary data was compromised by the problem of time-consuming coding procedures, that is, looking up assigned food code numbers that matched the food values to be determined. Expansion of food composition data made coding more timeconsuming. For example, there may be several varieties of a fresh fruit listed in the tables. An analyst may spend a great deal of time trying to match the fruit in question with the published food composition data. After locating the relevant code number, the data is fed to the computer for processing. Delays associated with confusing coding and decision-making procedures consumed the time saved by automated calculations. To remedy this problem, Witschi et al. developed a simplified computer-based table of nutritional values and an interactive retrieval system. They called it Quick Input of

32

Clinical Nutrition Foods program. It was designed to be used directly by nutritionists while interviewing patients, or for nutritional analysis of recipes, menus, and dietary records. The Quick Input of Foods program consisted of many averaged nutrient values. It allowed easy access to the data base, quick computation, and rapid evaluation of dietary intakes. Computation of dietary intakes revealed that the compressed data base compared favorably with manual calculations and the more detailed Case Western Reserve computerized table of nutrient values. This development further enhanced the utility of computers in the practice of dietetics. The Quick Input program eliminated manual coding, reduced arithmetic errors, and accelerated decision-making in selecting and quantifying foods. Its main advantage was that it was immediately accessible online and could thus generate immediate feedback which could be used while counseling a patient. Users of the program commented that in addition to the attributes outlined above, the system helped improve dietary interviewing skills and by implication the counseling process.

35.

Wyse, Bonita W. "Nutrient Analysis of ’Exchange Lists for Meal Planning.’ Part I: Variation in Nutrient Levels." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 75 (September 1979): 238-242. It was reasoned that computers could perform the tedious calculations to determine variations in nutrient levels of the Exchange Lists. Therefore, the nutrient values used in the 1976 Lists were compared with published food composition data to determine how the two corresponded. Wyse found wide variation in the caloric and nutrient values in each of the groups in the Exchange Lists. Once again the computer proved its value in performing calculations that would otherwise be prohibitive in terms of time and resources. Computers enabled nutritionists to compare the nutritive composition of many foods efficiently. In turn, it

Assessment of Nutritional Status

33

facilitated the design of more precise diet plans used to remedy certain illnesses. Also, computerized analysis of the Exchange Lists make dietitians aware of the most disparate values. With such information readily available, improved diet counseling would result. Specifically, nutritionists could recommend more precise dietary adjustments based on a client’s customary diet while simultaneously considering variations in the nutritive values of individual foods on the Lists.

Wyse, Bonita W . , and R. Gaurth Hansen. "Nutrient Analysis of 'Exchange Lists for Menu Planning.’ Part II: Nutrient Density of Food Profiles." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 75 (September 1979): 242-249. Computers and the Index of Nutrient Quality (INQ) concept were combined to analyze the individual foods in the Exchange Lists for Meal Planning. It was thought that displaying nutritive information graphically would be more useful than tabular data as presented by Wyse (item 34). A major advantage of graphic representation of nutritive data over the tabular format was noted. It was that one could discern at a glance the nutritional strengths and weaknesses of individual foods on the Exchange Lists. Moreover, dietetic professionals could use such profiles in summary form, that is, considering either one meal or a typical day's intake. Such summaries could be used to facilitate diet counseling and to communicate nutrition information about the Exchange Lists in a meaningful way. The researchers concluded that clients could benefit from the expanded nutrition information highlighted by the INQ format. Finally, this approach had been validated in another context. It was used in a nutrition education program for children in grades K through 6, demonstrating that approaches to diet instruction could be modified according to a patient's educational level.

34

Clinical Nutrition

NUTRITIONAL MANAGEMENT OF DISEASE

37.

Anderson, Kathryn, Barbara Kennedy, and Phyllis B. Acosta. "Computer-Implemented Nutrition Support of Phenylketonuria." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (December 1985): 1623-1625. Researchers from the Florida State University developed and clinically tested a microcomputerimplemented nutrition support system for use with phenylketonuria (PKU) patients. The program was called, PKU CALC. It was designed for use by dietitians to facilitate filling diet prescriptions for infants, children, and adults afflicted with PKU. The system was useful for quick computation of PKU diets along with an analysis of the formulas used in the management of the disease. For example, if a diet prescription called for a combination of two formulas, the calculations were facilitated by the microcomputer program since manual methods were very time-consuming. One of the major features of the system was that it enabled clinicians to try various combinations of foods and formulas and to correct any nutrient deficiency in order to optimize the nutritional support of PKU patients. The authors concluded that a computer could be used to fill diet prescriptions, but only if a nutritionist who knows how to fill them is involved in its programming. This was attributed to the expertise and training necessary to establish a diet prescription and selection of appropriate formulas.

38.

Goodloe, Mary Helen, Grady Waters, Carrol Quinlan, and J. Gordon Barrow. "Studies in Atherosclerosis. 4. Electronic Computers in the Processing of Dietary Data." AMERICAN JOURNAL OF CLINICAL NUTRITION 13 (November 1963): 304-311. Work was undertaken to study the difference in diet patterns of two Catholic religious orders. One was a lacto-vegetarian order (Trappists), while the

Nutritional Management

35

other (Benedictines) consumed a typical American diet. Their aim was to investigate the effects of various levels of fat intake on the occurrence of atherosclerosis. This condition, commonly referred to as "hardening of the arteries," is a cause of heart attacks. It has been the major cause of death among middle-aged American males for most of the twentieth century. In a preliminary pilot study, 150 monks participated. It took ninety minutes for a nutritionist to analyze the diet of each candidate per study day using pencil-and-paper and desk calculators. For this reason a computer program was developed in 1958 to calculate the individual dietary consumption of the participants of the major study involving approximately two thousand monks. The objective of the computer program was to translate raw food consumption data into the number of calories and the amounts of nutrients, including vitamins and minerals, consumed by each monk on the given day of the study. The researchers concluded that it was both feasible and practical to use computers in such large-scale dietary studies. They further noted that large volumes of data could be more accurately processed in much less time with less professional personnel than with the use of conventional methods.

Wyatt, Jan. "Computerized Nutritional Analysis System for Burn Care." JOURNAL OF DIETETIC SOFTWARE 1 (Summer 1984): 7. A microcomputer-based nutritional analysis program for burn care was described. It was designed to improve patient care by increasing the efficiency and accuracy of assessing the daily nutritional status of burn patients. Data generated by this system enabled burn unit staff to evaluate the effectiveness of care plans in providing needed nutritional support for the thermally injured patient. The system was programmed to (a) determine and update burn patients’ nutritional requirements using various formulae; (b) analyze the daily nutrient

36

Clinical Nutrition content of all oral, enteral and parenteral feedings consumed by the patient; (c) identify deficiencies or excesses of essential nutrients in the patient’s diet; and (d) provide long-term patient histories. The system was reported to be in the implementa­ tion stage. However, it was useful enough to meet the burn center's need for more consistent nutri­ tional data while providing nutritionists with a working knowledge of the burn patient's nutritional status. An update of this article appears in item 40.

40.

Wyatt, Jan. "Update: in a Burn Center." (Fall 1984): 7-8.

Computerized Nutrition Analysis JOURNAL OF DIETETIC SOFTWARE 1

Updating item 39, Wyatt presented an expanded chart including the formulae used to calculate stress/burn calories required. Calculations showed the variance in kilocalories for each formula applied to a sample patient using the microcomputer-based nutritional analysis system for burn care.

DRUG-NUTRIENT INTERACTIONS

41.

Roe, Daphne A. "Prediction of the Cause, Effects, and Prevention of Drug-Nutrient Interactions Using Attributes and Attribute Values." DRUG-NUTRIENT INTERACTIONS 3 (1985): 187-189. One of the most practical and innovative uses of computer technology was to use it to predict the cause, effects, and prevention of drug-nutrient interactions using attributes and attribute values. A number of adverse effects of drug-nutrient inter­ actions have been identified via clinical observa­ tions, clinical investigations, and literature reports. Roe reported that by combining knowledge of the attributes of a given drug, with an available knowledge base management system for microcomputer use, prediction of the mechanism and effects of drug-nutrient interactions could be facilitated.

Drug-Nutrient Interactions

37

The author cited examples to illustrate this approach. Roe predicted that in the future many opportunities will arise to use such systems to investigate complex drug-nutrient interactions.

MODIFICATIONS OF THE NORMAL DIET

42.

Balintfy, Joseph L., Lilly M. Lancaster. "FASTEX: Computing Best Fit Individualized Exchange Patterns.” JOURNAL OF DIETETIC SOFTWARE 2 (Fall 1985): 2-6. A computer-based system for computing individual­ ized diabetic diets specifying zero tolerances in advance of calculations assures better control and accountability. A BASIC computer program, FASTEX, was written for such a purpose. The program initially prompts the user to input the desired caloric tolerance followed by the minimum protein allowance in grams and the fat content expressed as a percentage of the total calories. The caloric tolerance may be limited by the user to five calories. Use of the FASTEX system generates individualized exchange patterns for diabetic diets. It enables dietitians to calculate such diets more precisely, exert greater control over the diet prescription, while reducing routine computational tasks. The complete FASTEX program is listed. Item 1 presents an update of this application.

43.

Dubin, Stephen, and Anne Jackson. "Automatic Calcu­ lation for the Renal Diet.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 84 (May 1984): 568-573. An algorithm for computing renal failure diets is presented for use with a programmable calculator. The program is interactive and foods may be added or deleted without re-entering previous data. The program outputs present, in percentage terms, the water, protein, calories, carbohydrates, sodium, potassium, calcium, phosphorus, and the dietary essential amino acids (DEAA) content of the diet analyzed. Also, an index of relative protein quality is computed on a meal-by-meal basis along with the

38

Clinical Nutrition limiting DEAA. The ability to explore and rapidly document a wide variety of meal plans is considered a major contri­ bution of the program. It was conceded that although the program met its objectives well and was suitable for professional use, it was not, however, sufficient­ ly "user-friendly" for patients to use. Improvements in this area will facilitate application with patients

44.

Marshall, Mary W . , and Joseph T. Judd. "Calculated vs. Analyzed Composition of Four Modified Fat Diets.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 80 (June 1982): 537-549. Nutrient content of four experimental diets, calculated to meet the needs of adult men and varying types and levels of dietary fat, were calculated by computer. These were compared with bomb calorimetry values, saturated fat, oleic acid, and linoleic acid agreed closely with calculated values. However, other nutrient values such as fiber, iron, cholesterol, and vitamin C exhibited the greatest differences between calculated and analyzed values.

45.

Oexmann, Mary J. "Automated Diet Construction for Clinical Research." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (January 1983): 72-75. The successful use of computers for automated diet construction was also found useful for conducting clinical nutrition research on patients and normal volunteers. Computers were programmed to satisfy nutrient specifications for individual research protocols while simultaneously satisfying a subject’s food preferences and nutrient requirements. According to Oexmann, the most outstanding feature of the system was its interactive capabilities. Four types of dietary manipulations were possible. Fol­ lowing execution of each dietary manipulation, the computer presented a display of the menu, indicating the portion size of each food and its nutrient cal­ culation. The computer automatically tabulated the nutrient totals for the menus planned. If diet

Modifications of the Normal Diet

39

planning goals were not met, further manipulations were possible. The author emphasized that experience had demonstrated that computer interactivity not only increased accuracy, but also reduced the time needed to calculate complex diets.

46.

Suitor, Carol W. , Richard F. Suitor, and Merril 0. Adelman. "Planning High-Carbohydrate, High-Fiber Diets with a Microcomputer." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (March 1983): 279-282. Current research suggests that a high-carbohydrate, high-fiber diet may be beneficial in the management of a number of diseases. These include diabetes mellitus, hypertriglyceridemia, and hypercholesterolemia. Researchers from the New England Medical Center in Boston developed a microcomputer software package designed to plan such diets. A major goal was to individualize the diets by generating menu patterns that met the patients' food preferences and diet prescriptions. Printed educational materials were used as adjuncts to the diet instruction in order to strengthen the approach. This research demonstrated once again that well developed software can be used effectively to in­ dividualize therapeutic diets. Thus, the probability of patient compliance is increased. Furthermore, this research illustrated that a comprehensive approach to diet planning can be facilitated in large part by microcomputers.

47.

Wheeler, Lawrence A., Madelyn L. Wheeler, and Patricia Ours. "Computer-Selected Exchange Lists Approxima­ tions for Recipes." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (June 1985): 700-703. Despite numerous nutrient analysis programs avail­ able for use with inexpensive microcomputers, none existed that would automatically determine the best Exchange List representation of a recipe in terms of minimizing the difference between assigned nutrient content of the Exchange Lists amounts and the actual nutrient contents of a recipe. In response to this need .a computer program was developed to assist dietitians and patients in determining the best Exchange Lists

40

Clinical Nutrition for Meal Planning representations for a serving of a recipe. The program was written in FORTRAN to run on a Digital Equipment Corporation DEC 10 mainframe computer. The program automates the selection of the best Exchange List recipe serving approximation while yielding a 26-nutrient analysis of one serving of the recipe and a breakdown by recipe ingredients. This recipe analysis program was tested on 200 recipes derived from Volume II of the AMERICAN DIABETES ASSOCIATION/THE AMERICAN DIETETIC ASSOCIATION FAMILY COOKBOOK. The time required to analyze a typical 10-ingredient recipe for all 26 nutrients was compared. It took an experienced dietitian 117 minutes to code, enter, and evaluate the work using conventional methods. Using the computer-based method to do the same job took 17 minutes. It took 6 seconds of actual computer time to process the work. The program will be rewritten to run faster. Also, a microcomputer-based adaptation, for the IBM PC was contemplated.

48.

Wheeler, Madelyn L., and Lawrence A. Wheeler. "Nutrient Menu Planning for Clinical Research Centers." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 67 (October 1975): 346-350. Researchers at the University of Florida Clinical Research Center developed a computer program for the dietetic service. It was used for menu planning and nutrient analysis for selective, nutrient-controlled diets and constant diets. The program computed food weights for a patient-selected daily menu satisfying up to twenty-three nutrient constraints. The com­ puterized technique saved dietitians substantial time in calculating the nutrient content of diets and planning diets with several nutrient constraints. It was also used as a teaching resource for dietetic students and interns. The authors described other advantages of the computerized system besides automatic calculations of nutrient-constrained diets including (a) availability of a complete nutritional analysis for a day to

Modifications of the Normal Diet

41

medical investigators and research dietitians, (b) food amounts and cost data useful in financial assess­ ment and food inventory control, and (c) comparison of planned diets with the Recommended Dietary Allowances as a guideline for planning long-term diets.

PATIENT MANAGEMENT AND COUNSELING

49.

Dean, Judy. "Use of Computerized Medical Records." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 71 (Novem­ ber 1977): 533. A Registered Dietitian from Loma Linda (California) Medical Center, reported on the use of computerized medical records by the dietary staff of the hospital and by dietetics students. This was possible because the hospital had subscribed for years to the Profes­ sional Activities Survey (PAS) of the Commission on Professional and Hospital Activities, a not-for-profit research body. One of the services provided by this organization was periodic printouts of medical records categorized in various ways. This made it possible for the dietary staff and students enrolled in the Univer­ sity’s coordinated undergraduate program in dietetics to undertake a variety of meaningful research projects. The author intended to suggest applications of the PAS system to other clinical dietitians by describing past examples of student projects and staff uses. Three examples of student research projects were described. One project involved the identification of patients who had been instructed on low-cholesterol diets during hospitalization. The study reinforced in students’ minds the value of explaining to patients not only the components of the diet, but its rationale. A second project involved generation of a list of the types of diets prescribed. This information enabled students to determine physicians’ diet prescription patterns. In a third study, students compared the dietary treatment of hospitalized patients with the same diagnosis. This allowed for evaluation of the quality and quantity of the prescribed diets. Findings prompted formulation of better diets in order to improve the nutritional status of patients on

42

Clinical Nutrition restricted diets. The Medical Center’s dietary staff conducted a study to determine the frequency and duration of special pre-surgical diets. Results from the study were used to guide the medical staff to improve the nutritional value of the diets they would prescribe for such patients. Finally, clinical dietetics instructors found the computerized medical records system useful in plan­ ning instruction. They were able to identify the charts of patients with specific diagnoses more ef­ ficiently for students to study such cases. Further­ more, retrospective studies were conducted to determine trends in diet prescription patterns over time. Moreover, diet ordering patterns at the time patients were discharged were studied in order to anticipate patient learning needs and to plan counseling strate­ gies.

50.

Dunphy, Marlys K., and Barry D. Bratton. " A Computerized Dietary Order Entry System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (January 1983): 68-71. Researchers from the University of Iowa’s Hospitals and Clinics described the development and implementa­ tion of the computerized Dietary Order Entry System. Its primary purpose was to accurately communicate orders and messages instantaneously from the patient care units to the appropriate floor diet offices. Five types of information may be transmitted via the system: (a) diet tray orders, (b) requests for dietitian services, (c) special formula orders, (d) special nourishment requests, and (e) free text mes­ sages . The Dietary Order Entry System worked as follows. Upon admission to the hospital, a patient was pre­ scribed a diet. Nursing personnel transmitted patient diet information obtained from the medical chart into the computer patient data base via video terminals located at the patient care units. Automatically, a copy of the diet order was transmitted to the printer terminal located in the appropriate floor diet office.

Patient Management and Counseling

43

Copies of the orders were used to guide follow-up care by the dietitian. It was possible to automatically generate three types of daily management reports with the system: (a) the diet list, which included the diet order for every patient according to patient care unit; (b) the daily diet census, which provided a count of the orders for each type of diet by patient care unit and a total for the entire hospital; (c) a birthday list, of all patients who had birthdays on a given day, so they could receive a cake with their dinner. Overall, the consensus of the dietary and nursing personnel was that the system was accurate in trans­ mitting messages and beneficial in terms of the time it saved. The researchers were convinced that im­ proved patient care would result from this advanced method of ordering diets.

Hoover, Loretta W . , and Donice J. Meylor. "Clinical Dietitians Use Computer-Generated Worksheets." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 69 (October 1976) 404-406. Making good use of their advanced computing capa­ bilities and staff support, two members of the Department of Nutrition and Dietetics from the Uni­ versity of Missouri-Columbia Medical Center developed a computer-generated worksheet for use by their clinical dietetians. They were addressing a gap in hospital admission data processing procedures which often excluded dietetic information. Nonetheless, the researchers reasoned that useful forms could be computer-generated to facilitate patient nutritional care using existing computerized admissions data. The existing computer-stored admissions census file was used as a data base for a program that would print a clinical dietitian’s worksheet. It included the patient’s name, birthdate, and location. The form was generated on 81 /2 X 11 in. paper. It allowed entries for ten patients per page. Space was provided for recording diet orders, diagnoses, and remarks. Clinical dietitians received updated worksheets two times per week.

44

Clinical Nutrition The outcome was that clinical dietitians were en­ couraged to maintain patient information using a standardized format. The authors concluded that the form yielded greater accuracy in terms of notekeeping, was convenient, and contributed to more efficient patient care. Finally, the authors de­ scribed the cost of development and use as nominal. This experiment illustrated once again how computers facilitated the work of clinical dietitians.

52.

Knehans, Allen, W . , and Ronald A. Ratliff. " A ComputerAssisted Weight Control Program.” JOURNAL OF DIETETIC SOFTWARE 2 (Spring 1985): 4-8. A computer-assisted weight control program may include features that are expensive and time-consuming to integrate into conventional approaches. The major components of a computer-assisted weight control program are described. These include body composi­ tion analysis, determination of interests, needs and goals, estimation of energy expenditure levels, and prescription of diet and exercise programs. Although no specific examples were presented, it was concluded that computers can be valuable in weight control programs by reducing the time and costs for both the health professional and the patient. Additionally, it was noted that when computer-based methods are com­ bined with behavioral therapy and other educational strategies, professional effectiveness is enhanced.

53.

Lakness, Jean A., and Mary K. Doyle. "Computer-Assisted Revision of a Community Diet Manual." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 76 (May 1980): 477-479. The Joint Commission on the Accreditation of Hospitals mandates that diets described in diet manuals be specified if they fail to meet the ap­ propriate Food and Nutrition Board’s Recommended Dietary Allowances (1980). This implies that diets must be analyzed for their nutrient content so that their deficiencies may be described. In the first revision of the Cincinnati Diet Manual pencil-andpaper calculation of the nutritional analyses were found to be tedious and time consuming. The authors reasoned that a computer would make the job more efficient because it would do it with greater speed

Patient Management and Counseling

45

and accuracy and at a smaller cost. Computing services were donated by a local hospital. These included computer time, key punching, and use of a nutritional analysis program called, NUTACC, which derived its nutrient data base from USDA AGRICULTURE HANDBOOK NO. 8. The authors described the steps involved in using computers to analyze the menus listed in the diet manual. Once the data was keypunched and processed by the computer, a four-page printout was generated. It included a list of the menu items analyzed, nutrient totals for each day for nineteen nutrients, and a page of statistical information summarizing the days anal­ yzed. They confirmed that the computer saved them time compared to manual methods.

Miller, Linda G. "Computerized Interviewing System for the Obese." JOURNAL OF NUTRITION EDUCATION 8 (OctoberDecember 1976): 169-171. In Boston's Beth Israel Hospital Nutrition Clinic, researchers successfully integrated an innovative computer-assisted nutrition history and behavioral approach program in treating obesity. The patients’ first encounter with the computer system was in a self-instructional sequence on how to interact with the computer. This was followed by three other steps. The first was a computerized diet history designed to help the patient characterize his or her problem in achieving weight loss. The second step was to analyze the patient’s food intake for a typical day. The patient was required to reconstruct, in sequence, all foods and snacks eaten on such a day. In the third step, a suggested meal pattern was provided, reflect­ ing the patient’s lifestyle and food preferences. The counseling sessions were conducted during several visits to the Clinic. An initial short visit was designed to outline for the patient the long-term program, which consisted of exercise, diet, recordkeeping, and follow-up visits to the Nutrition Clinic. About 85% of those patients who were scheduled for a second long visit returned. Its purpose was to assist patients in establishing a weight reduction diary.

46

Clinical Nutrition Future follow-up visits began with a discussion of the patient’s food diary with the nutritionist. These researchers demonstrated that computerassisted nutrition history, in conjunction with a treatment process focusing on behavioral change, re­ sulted in more efficient use of a nutritionist’s time, promotion of some weight loss, and favorable changes in patients’ attitudes towards exercise, while placing the responsibility for successful weight loss on the patient.

55.

Slack, Warner, Douglas Porter, Julia Witschi, et al. "Dietary Interviewing by Computer." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 69 (November 1976): 514-517. Researchers at Harvard University wanted to test two hypotheses concerning the computerized inter­ viewing system used at Beth Israel Hospital to counsel obese patients, one, that preliminary com­ puterized interviews can assist nutritionists in their subsequent dialogue with their patients; and two, that automated dietary counseling can directly aid patients in organizing their thinking about eat­ ing and planning their diets. These researchers also wanted to confirm their belief that interacting with a computer was indeed a pleasant as well as a per­ sonalizing experience. In order to test the hypotheses, sixty-four volunteers, thirty-two male and thirty-two female, with the diagnosis of simple overweight, were ran­ domly selected. None of those selected had received professional dietary help within two months prior to the study. Questions, explanations, and computerized assistance were available from a computer monitor screen in English. Patients responded to questions using a typewriter-like keyboard. All subjects were interviewed by a computer and by a nutritionist. Half of the subjects were interviewed by the computer first and then by the nutritionist, the other half vice versa. Men and women were assigned to each group on a random basis. Two weeks elapsed between the personal interview and the automated one.

Patient Management and Counseling______ 47 Two expert nutritionists had been recruited to conduct the personal interviews. They were selected on the basis that they were able to work objectively and independently. Additionally, these professionals had no previous exposure to the design and implemen­ tation of the computerized techniques. The results of the experiment suggested that com­ puterized interviews were helpful to the nutritionists in their subsequent discussions with their patients about their weight reduction diets. The sessions were shorter without any loss of rapport. Another finding was that the computer was better at asking questions than at answering them. The researcher planned to make future versions of the program more responsive to questions which patients may ask during the auto­ mated interviews. These investigators were confident that in the future computers would be helpful in studying the relative effectiveness of various types of dialogues with weight reduction patients. They further antici­ pated that revised versions would provide effective counseling for people without access to professional help. Also, future systems could serve patients with hyperlipoproteinemia and diabetes mellitus, as well as the overweight.

56.

Weathers, Barbara J., Loretta W. Hoover, William J. Warriner, James D. Dillon. "Computerized Clinical Dietetics Management Systems." JOURNAL OF THE AMERI­ CAN DIETETIC ASSOCIATION 86 (September 1986): 12171223. Following years of intensive development of com­ puter applications in nutrition and dietetics, re­ searchers from the University of Missouri-Columbia Hospitals and Clinics unveiled their advanced com­ puterized clinical dietetics management system (CDMS). It was designed to facilitate and support accurate and timely delivery of clinical dietetics services. The CDMS was an integral component of the hospital's com­ prehensive computer system. It interfaced with 17 existing data bases. Additionally, it was capable of handling 31 useful functions, including patient in­ quiries, message transmission, charge capture, calcu­ lations, data base maintenance, and management

48

Clinical Nutrition reporting capabilities. The system featured continu­ ous and immediate access to the most current patient information, a complete diet history for each patient, and minimal printed output. The authors reported that the system resulted in improved worker efficiency during peak periods and a reduced number of wasted trays, while solving problems with greater effective­ ness and speed. Without doubt, a major contribution of the system was that it increased the visibility, and by implication, the reputation of clinical die­ tetics services. Finally, the dynamic nature of the system allowed incorporation of additional applica­ tions as they would become available.

57.

Wheeler, Lawrence A., and Madelyn L. Wheeler. "Computer-Planned Menus: A Prospective Diet Assessment Method." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (March 1985): 347-349. Expanding on their previous work with computerplanned menus (CPM) for patients with diabetes mellitus, the authors developed a prospective approach to assess diabetic patients’ compliance with their prescribed diets. When the authors compared the CPM method with other diet assessment methodologies, they concluded that CPM possessed the following advan­ tageous features: (a) it served as a direct aid in following the diet, (b) it provided patients with immediate feedback following training, (c) the diet information was recorded immediately, (d) the system did not require the patient to rely on mere recall of past food intake, and (e) large amounts of data were obtainable from the system. The authors' approach indicated that the computerbased system (CPM) was effective in assisting patients in adhering to their prescribed individualized meal patterns while simultaneously instructing patients on the correct use of the Exchange Lists. Their work demonstrated that the computerized systems could serve not only as a prospective diet assessment tool but as an educational vehicle to guide patients in following their prescribed diet.

Patient Management and Counseling 58.

49

Witschi, Julia, D. Porter, S. Vogel, R. Buxbaum, F. Stare, and W. Slack. "A Computer-Based Dietary Counseling System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 69 (November 1976): 385-390. Researchers from Harvard University's Department of Nutrition reported on the design and development of a computer-based dietary counseling system. This work was preceded by many experiments that tested computer-based medical histories designed for various medical fields. The authors described a preliminary trial of a program in which the principles of patientcomputer dialogue were applied to dietary counseling. The purpose of the program was to obtain an overweight patient's diet history, which would form the basis of diet instructions and guidance for their dietary behavior . Volunteer participants interacted with the computer via questions and suggestions presented to them on the computer's cathode ray screen and responded using a typewriter keyboard. There were many alternative pathways through each interview. These were deter­ mined by the participants’ responses. All transactions were stored on magnetic discs which were later used to collect summary statements to be printed fol­ lowing the interview. The counseling system consisted of three parts: "Dietary History," "Analysis of Food Intake for a Usual Day," and "Diet and Menu Planner." The program contained a total of 375 questions, requests, and explanations embedded within the three sections. The "Dietary History" section elicited information which characterized eating behavior, determined weight patterns, and defined weight control problems. The second section, "Analysis of Food Intake for a Usual Day," was designed to assist patients in listing sequentially all foods ingested at meals and snacks during a typical day, including weights and measures. The dialogue had built-in capabilities to prompt the patient to recall an accurate dietary history. The third section, "Diet and Menu Planner," enabled patients to interact with the computer to plan menus, for one or more days, ranging from 1,200 to 1,700 kilocalories per day. These could then be printed for

50

Clinical Nutrition the patient to follow. This experiment pointed to several important con­ siderations with respect to patient-computer dialogue These included limitations in the choice of responses ambiguous questions, and matters of courtesy. It was concluded that a computerized interview should be responsive to human sensitivities for it to be favor­ ably accepted by patients. In a word, courtesy was found to be an essential component for a successful interview. All in all, the results provided meaning­ ful insight into procedures for conducting computer­ ized dietary interviews.

CHAPTER III COMMUNITY NUTRITION

INTRODUCTION

Community nutrition is involved in the surveillance and assessment of the nutritional needs of the community. Nutritionists specializing in this area typically identify nutritional problems and assess community resources through nutritional and dietary surveys. They subsequently plan, implement, and evaluate community nutrition programs on the basis of their assessment. Areas of community nutrition include (a) nutrition education of the public, (b) legislation and public policy related to foods and nutrition programs, and (c) international policies and programs.

59.

Balart, L., M.C. Moore, L. Gremillion, and A. Lopez-s. "Serum Lipids, Dietary Intakes, and Physical Exercise in Medical Students." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 64 (January 1974): 42-46. In a study of 104 freshman medical students at the Louisiana State University (LSU) Medical School in New Orleans, a number of variables were considered to identify early risk factors leading to the development of coronary heart disease. Among the variables studied were dietary intakes. These were analyzed from seven-day dietary histories completed by the medical students. A computerized technique developed by LSU researchers was used.

51

52

Community Nutrition It included a foods data base of items ordinarily consumed in this part of the country. The computerized method permitted fast evaluation of 69 dietary nutrients instead of the 21 listed in the most common foods composition book available then, USDA AGRICULTURAL HANDBOOK NO. 8. Therefore, with the aid of computer technology it was relatively easy to compute dietary analyses for 104 subjects for 69 components. These results were then compared to serum lipids and physical exercise among the medical students. Thus, the computer demonstrated that it was a valuable tool in identifying nutritional variables which could impact on the development of coronary heart disease.

60.

Casbergue, John P. "Concepts for the Future... School Food Service and the Computer." SCHOOL LUNCH JOURNAL 21 (June 1967): 11-14. Computers were found feasible in the operations of the national school lunch program. Five areas of application had been identified: (a) menu planning, (b) purchasing and inventory control, (c) planning for food preparation, (d) cost and nutritional data analysis and evaluation and (e) simulations of kitchen designs and layouts.

61.

Eckstein, Eleanor. "The Computer and the School Lunch Program." SCHOOL LUNCH JOURNAL 23 (November/December 1969): 28, 30, 32, 35. It was proposed that computers could be used to plan acceptable school lunch menus meeting nutritional guidelines at prices affordable to the pupils. The author cautioned that before this would be possible food preference information had to be gathered in order to build a preference data base that would facilitate menu planning.

CHAPTER IV MANAGEMENT

INTRODUCTION

A significant portion of the work of the modern nutri­ tionist involves skillful management. The training of food and nutrition professionals involves detailed study of man­ agement theory. The areas included are (a) management theories and their applications, (b) management functions, including planning, organizing, staffing, directing or coordination, and controlling, (c) policies and procedures related to safety in the workplace, (d) labor-management relations, (e) management-related legislation at all levels of government, and (f) management information systems in­ volving computer applications in dietetics and nutrition.

MANAGEMENT FUNCTIONS

62.

Fromm, Barbara, Aimee N. Moore, and Loretta W. Hoover. "Computer-Generated Fiscal Reports for Food Cost Ac­ counting." JOURNAL OF THE AMERICAN DIETETIC ASSOCIA­ TION 77 (August 1980): 170-174. Computer technology, as employed in management information systems, permits sophisticated data man­ ipulation, storage, and retrieval to generate useful documents for managerial decision-making. These features are desirable in both commercial and dietetic food service operations. An application of this

53

54

Management technology includes computer-assisted food cost ac­ counting procedures. These enable managers to quickly assess financial variables affecting their operations. Thus, fluctuations in prices, revenues, and expenses may be assessed relative to the financial status of the operations. Considering these advances in computer technology, the authors undertook a project to redesign the exist­ ing computerized food cost accounting system at the University of Missouri-Columbia, Department of Nutri­ tion and Dietetics Medical Center. The system had been in place since 1966. Among the improvements sought were the automatic generation of comprehensive food service operation fiscal reports for all the feeding units of the Medical Center. Following the redesign and testing of the computer­ ized food cost accounting system, personnel from the computer center and food service were notified of changes in the operating procedures. Checks were con­ ducted to verify the accuracy of the new system. Once fully implemented, the new system automatically gen­ erated daily summary and ledger reports for the major cost centers of the hospital. The redesigned system was found to be a substantial improvement over its predecessor. Reports generated by the revised system were more accurate, contained a greater number of operational details, and were slightly less expensive. Several conclusions were drawn from this work. First, food service management information systems must be periodically evaluated to meet changing administra­ tive needs. Second, substantial changes in the opera­ tion of food service systems warrant improvements in food cost accounting procedures. By implication, com­ puter-based systems should also be upgraded simultan­ eously. Third, advancements in computer technology call for modification of existing procedures to keep pace with increased demands for timeliness and accuracy of reports generated. The researchers concluded that emerging improvements over current systems or enhance­ ments of existing applications could significantly in­ crease the efficiency of both commercial and health care food service operations.

Management Functions 63.

55

Gelpi, Mary Jane, Joseph L. Balintfy, Lyman C. Dennis, and Irene K. Findorff. "Integrated Nutrition and Food Cost Control by Computer." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 61 (December 1972): 637-646. Between the years 1968 and 1969, researchers at Tulane University conducted a study to compare the raw food cost, nutritional content, and palatability of conventional menu plans versus menus planned with computer assistance. These researchers approached menu planning as a mathematical problem. They strongly believed that the computer was the tool of choice for carrying out the mathematics of balancing diets. These researchers confirmed their predictions. They found that computer-assisted institutional menu planning yielded better control of nutrients and palatability over conventional methods. Likewise, they found that computer-assisted menu planning could reduce costs substantially. This study was conducted using a specially designed online computer configuration running on a special­ ized computer program. The actual diet planning systems were developed by the researchers and were not immediately convertible nor applicable to hos­ pital food production situations. Nonetheless, the researchers outlined some of the major cost factors associated with computer-assisted menu planning sys­ tems, which included (a) the computer system, (b) development of the data base, (c) installation of the system, (d) operation of the system, and (e) contribution to the maintenance cost of the computer being used. These workers concluded that such a computerized menu planning system useful for regular and multi-diet systems added a new dimension to food service management.

64.

Hicks, Zita R. "A Computer-Based Decision Support System Aids Distribution in Planning and Control of Foodservices." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 86 (September 1986): 1182-1188. The importance of information management in

56

Management dietary departments has been enhanced since the introduction of prospective pricing and reimbursement of hospitals based on diagnosis-related groups (DRGs). Three scenarios, developed from typical food service situations, were simulated to test a computer-based decision support system. The scenarios consisted of (a) an analysis of price changes and discounts from a potential vendor, (b) menu planning and pricing for a holiday dinner for 800 to 900 employees, and (c) a cost comparison between 1 day of meals for a patient on a general and diabetic diet. The researchers had two purposes. One, to describe how information was organized for a specific food service implementation. Secondly, to illustrate the usefulness of a decision-support system for the dieti­ tian. The system is called Interactive Foodservice Decision Assist Methods (IFDAM). The usefulness of the IFDAM system to the dietitian was demonstrated in the three scenarios. Dietitians tested the system to (a) plan and analyze changes prior to implementation, (b) base decisions on precise rather than arbitray information, (c) justify and document menu item costs, and (d) rapidly retrieve current price information of ingredients and menu items. Following collection, organization, and input of food service information into the IFDAM program, the dietitian interactively selected and retrieved data. The system enables dietitians to solve problems and appraise alternative scenarios. The ability to simulate food service situations and create "what if" scenarios aids the dietitian in decision making. Also, the matrix data structures, the command structure, and the interactivity of the system enables dietitians to process information ef­ ficiently .

65.

Spears, Marian C., and Allene G. Vaden. "ComputerAssisted Management." FOODSERVICE ORGANIZATIONS. Chapter 22. New York: John Wiley & Sons, 1986, 644659. Increasing computerization of professional activi­ ties requires that dietitians become acquainted with

Management Functions

57

computer applications in food service systems. Over the years, dietitians only learned about computer ap­ plications by way of special learning situations or on-the-job training. Textbooks lacked such information. This textbook devotes a detailed chapter to com­ puter-assisted management. It covers its historical development, the elements of information processing systems, and computer applications in food service sys­ tems. Inventory and production control are two areas in which computer assistance had been applied most frequently in food service operations. Also, com­ puters have assisted with financial management and cost control procedures. Considerations for imple­ menting computer-based systems in food service are discussed. The increasing sophistication of hardware and soft­ ware packages has warranted that food service managers and administrative dietitians become computer literate. This chapter, in a professional textbook, goes a long way to introduce the subject to the field.

66.

Tuthill, Byrdine H. "Dietitians Use Computer Assistance to Contain Costs." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 76 (May 1980): 479-482. Tuthill reviewed and summarized the fifteen-year experience during which the computer played an integral role in her hospital’s dietary operations. She con­ cluded that computers were not only instrumental in upgrading the quality of dietetic services provided but that they were cost effective as well. The case on behalf of computers was made on the basis of the variety of functions they performed to assist management in containing costs. Tuthill listed and described fourteen different types of computer­ generated reports that managers could use to respond to economic pressures: 1.

Accurate and current reports that separated non-patient food costs from patient costs

2.

Income and expense reports from all food service

58

Management outlets in the hospital 3.

Food cost per patient day calculated on a daily, weekly, monthly, and year-to-year basis

4.

Portion costs for all foods served

5.

Reports detailing all items in storage, on hand, and on order

6.

Purchase orders generated automatically

7.

Standardized recipes adjusted to meet fore­ casts

8.

Costed standardized recipes

9.

List of foods to be removed from the freezer generated daily

10.

Nutritional analyses of menus

11.

Analyses of patient nutrient intakes

12.

Personnel costs by service area

13.

Individual personnel vacation, sick leave, and holiday report

14.

Labor cost for pay period per cost center

In sum, the fifteen-year history of computer use by the University of Missouri Medical Center in dietetics and food services resulted in no increase in the number of full-time equivalents to run the department. In fact, the output of the entire op­ eration changed significantly. For example, all members of the professional staff, including dieti­ tians and programmers, devoted twenty-five per cent of their time to the education of undergraduate die­ tetic students, which had not been the case before computers were integrated into the operation. Addi­ tionally, despite a period of rapid inflation, com­ puters allowed careful monitoring of departmental expenses and deficits were avoided. Traditional means of addressing adverse cost influences on hospital food service operations were found inappropriate. The

Management Functions

52 -

availability

of computer technology allowed managers to react immediately to spiraling food costs by en­ abling them to modify menus and recipes, and by facilitating other pertinent management decisions. Thus, Tuthill demonstrated the feasibility of im­ plementing effective and useful computer-based infor­ mation systems in administrative dietetics operations. It should be noted that substantial research and development funds went into this undertaking. Pro­ grammers, professors and graduate students worked many years to achieve what was reported. Nonetheless, it was made clear that computers had a major role to play in administrative dietetics.

LABOR/MANAGEMENT RELATIONS

67.

Shick, Gay L., Loretta W. Hoover, and Aimee N. Moore "A Computer-Assisted Personnel Data System for a Hospital Department of Dietetics. I." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 74 (April 1979): 448-453. Researchers from the University of MissouriColumbia Medical Center developed a data base for a computer-assisted personnel data system for the De­ partment of Nutrition and Dietetics. The researchers had eight objectives in mind when they set out to design the data base: (a) to develop a data base related to procedural differences among various cate­ gories of personnel; (b) to develop a security system; (c) to define the transactions that would create, maintain, and update the data base; (d) to compute sick leave, accrued vacation, and holiday time, and automatically calculate balances for full-time em­ ployees; (e) to Include an audit trail; (f) to maintain an employment record for each employee; (g) to retrieve online information found in the Master Personnel and Attendance Files; and (h) to generate reports with minimum programming effort using a file management system. In order to achieve the specified objectives, it was necessary to develop specialized computer programs

60

Management and files. Eight programs were written, designed to edit input data, sort and process data, and allow back-up of data files and transactions. Permanent files were created to store various categories of personnel data such as personal information, atten­ dance, and termination records. Historical records related to changes in employment status were generated automatically on demand. The authors reported that all programs were tested for accuracy before their final implementation. Based on successful results, the system was integrated as a module of the computer-assisted management information system of the Department of Nutrition and Dietetics. This work was expanded by Moe et al. (item 68).

68.

Moe, Glenna R., Loretta W. Hoover, and Aimee N. Moore. "A Computer-Assisted Personnel Data System for a Hospital Department of Dietetics. II." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 74 (April 1979): 454-457. Expanding on the work of Shick et al., Moe and colleagues (item 67) developed a series of computer programs to generate six labor accounting reports. These programs used data from the personnel data sys­ tem of the Department of Nutrition and Dietetics at the University of Missouri-Columbia Medical Center. The six reports were considered to have high priority by the administrative staff. They were de­ signed to assist in personnel management decision and control of labor costs. Information contained in the six reports included (a) monthly analysis of labor costs by work area, (b) total monthly labor cost by area and personnel category, (c) total monthly labor cost computer for the whole department, (d) turnover index by work area reported on a quarterly analysis of turnover, (e) a record of absenteeism, and (f) a list of employees in order of seniority. Following an evaluation of the utility, time and costs associated with generating the reports, based on the calculations performed and the information yielded, the computerized reports were considered cost effective.

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61

MANAGEMENT INFORMATION SYSTEMS

General References

69.

Aldrich, Doris S., and Lillian C. Helbig. "A Sequen­ tial Procedure for Implementing a Computer-Based Information System.” JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 86 (September 1986): 1228-1231. A step-by-step approach is proposed for those considering initial implementation of a computerbased information system (CBIS) including: (a) analysis of the existing system for potential use of CBIS, (b) formulation of the CBIS plan, (c) selection of system software, (d) selection of system hardware, (e) implementation of the CBIS, and (f) evaluation of the CBIS. A set of strategies.to effectively manage implementation of the system was also suggested. It called for the use of project management skills, identification of the roles of all concerned, and a phased implementation strategy. In sum, the authors warned that the success of the final phases of com­ puterization will depend on the effectiveness of the planning in the initial stages and management’s at­ tention to detail.

70.

Anonymous. ’’Case History of a Hospital Information System.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIA­ TION 68 (January 1976): 45-46. Details are provided on how a hospital informa­ tion system was used in dietetics. Such a system conformed to the eight attributes described by Ball and Jacobs (item 70). The food service department of El Camino Hospital, Mountain View, California (450 beds), interacted with the computer in a variety of ways. The department office had a printer that printed out a list of all hospitalized patients three times a day. The list was arranged by floor, room, and type of diet for each patient. This information was used to check for last-minute census accuracy before the assembly of diet trays.

62

Management The dietitian was able to enter progress notes directly from a video matrix terminal at the nursing station. Additionally, she was able to enter dif­ ferent kinds of information, including comments on the doctor's diet prescription, patient's dietary preferences, allergies, combination diets, and sup­ plemental feedings. Dietitians's comments usually follow her visits to the patients. Upon accessing the patient's file in question, the terminal displays the dietitian master guide which can be used to select a standard text to be entered in the patient care plan. If the desired text is not on file, then the dietitian has the option of typing and then editing her own comments on the keyboard. All notes become part of the patient's permanent medical record. The video matrix terminal at each nursing station was considered an important part of the patient care system. By using a light pen and a keyboard, a pre­ selected list of items could be accessed. For ex­ ample, these included laboratory tests and a list of modified diets. The latter, for example, was an aid to physicians in selecting the appropriate diet for their patients. Administrative and decision-making applications were used by the food service director in connection with the financial and business aspects of the de­ partment. For example, one way the director used the system was for computing employee productivity data. It took approximately one year to implement the system back in 1972. This included training and a gradual changeover period from the previous manual systems. The report also stated that since the sys­ tem was flexible, additions could be added in the future. Contemplated expansions of the system re­ lated to dietetics included menu planning, menu printout, menu tally, and nutrient analysis.

71.

Ball, Marion J., and Stanley E. Jacobs. "Computerized Hospital Information Systems and the Department of Dietetics." JOURNAL OF THE AMERICAN DIETETIC ASSO­ CIATION 68 (January 1976): 42-44. A hospital information system is characterized by

Management Information Systems

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eight features: 1.

Computers are involved and remote terminals may be located in nursing stations or most departments in a hospital.

2.

All or most of the departments interact with the system by entering data, receiving data, or both.

3.

From the start, the system was designed with the hospital's total needs in mind.

4.

Since the terminals are online to a main com­ puter, they may be used to enter and receive data at all times.

5.

The system is capable of accepting, storing, and communicating descriptive data as well as transmitting physicians' orders.

6.

Events are scheduled chronologically to avoid confusion (such as doctor's orders).

7.

The system monitors data, such as physician's orders, to see if they are carried out.

8.

The system maintains a complete medical record for each patient which can be accessed only by authorized personnel.

The authors discussed several potential benefits of hospital information systems in dietetics. For example, since all admissions, discharges, and transfers are handled by the system, the dietary department always has a current census. Such in­ formation avoids food waste associated with the preparation of diets for people who have been either discharged or transferred. In the case of newly ad­ mitted patients, their diets could be made available to them on short notice without delay since the sys­ tem notifies dietary immediately upon admission. In more sophisticated systems, dietitians could enter progress notes right from the terminal. Other applications in dietetics include menu planning and inventory control. The integration of hospital

64

Management information systems, Ball and Jacobs argued, allows dietitians to maximize their expertise by reducing the clerical requirements of conventional manual systems. Finally, the authors urged dietitians to become involved in long-range planning of additional com­ puter services to be incorporated into future hospital information systems.

72.

Dwyer, Johanna, and Carol W. Suitor. "Caveat Emptor: Assessing Needs, Evaluating Computer Options." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 84 (March 1984): 302-312. The characteristics of seven mail order diet anal­ ysis service vendors and five commercially available microcomputer programs were compared. It was reason­ ed that prospective users should carefully consider available nutritional analysis software because such programs may have serious shortcomings for particular applications. For example, coding difficulties may result if too few commonly used foods are included in the data base. Also, a program may not be useful if it contains insufficient choices for food serving sizes. The authors described other difficulties associated with nutritional analysis software, in­ cluding (a) an unclear user’s manual, (b) lack of procedures for correcting errors in data entered, (c) data that could easily be lost by hitting wrong keys, and (d) use of inappropriate nutritional standards such as the 1974 Recommended Dietary Allowances (RDA) instead of the more current 1980 revision (Food and Nutrition Board of the National Academy of Sciences, 1974; 1980). Difficulties related to printed output were also uncovered. In some programs it was not possible to obtain printouts, whereas others yielded printouts that were difficult to read and interpret. Finally, lack of flexibility plagued some programs, preventing updating of the data base. In view of rapidly ex­ panding nutrient composition information, such nu­ trient data bases could rapidly become obsolete. Similarly, some vendors of nutritional analysis services offered no updating services. This meant

Management Information Systems

65

that the latest nutrient information could not be used— a major drawback for nutritionists in need of the most current information. Based on the results of their findings, Dwyer and Suitor identified five areas that nutritionists should scrutinize when selecting a nutritional anal­ ysis system. First, the exact purpose should be spelled out. The rationale for this is that dif­ ferent analytical software is suitable for different purposes. For example, some are suitable for re­ search purposes, some for assessment of patients' nutrient intake, and others for patient education. Secondly, prospective users should carefully con­ sider whether the system selected is really worth­ while. The authors argued that many nutritionists can eyeball diet records and qualitatively identify nutrient shortcomings using their broad knowledge of nutrient sources from foods. Thirdly, the question of cost was addressed. Users should consider not only direct costs associated with acquiring software and the necessary hardware, but indirect costs as well. These hidden costs are related to updates, supplies, and, in the case of mail order vendors, mail expenses. A fourth requisite question dealt with software and hardware compatibility. In other words, is the equipment needed to run the desired software packages available? Finally, the fifth area identified for consideration dealt with the validity and reliability of existing data bases. Most micro­ computer programs studied and mail order vendors surveyed had data bases too small relative to the actual total number of foods available in the United States. Consequently, concern was expressed over what to do when food composition data was missing in a program. The authors concluded that there was a need to develop a protocol for making food substitu­ tions in order to improve the reliability of computer­ ized nutritional analyses. Notwithstanding, the authors conceded that the dynamic state of the field warranted continued scrutiny on the part of profes­ sionals prior to selection of any software system or vendor service, since new features and enhancements were emerging and prices falling rapidly. Dwyer and Suitor offered a final but important work of caution, concerning the necessity of

66

Management performing trial runs with the analytic software. They suggested that prospective users of the system under consideration should spend ample time getting the "feel" of a computer program. They further argued that demonstrations at conventions were too limited and did not allow sufficient time to learn a system. Moreover, they proposed that, in order to overcome the various limitations placed on reviewing software, vendors should refer prospective users to a nutritionist or other current user who will permit trial use and familiarization with the system. This would facilitate information exchanges by profes­ sionals concerning their experiences with different hardware and software configurations.

73.

Frank, Robyn C. ’’Information Resources for Food and Human Nutrition." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 80 (April 1982): 344-350. The geometric growth of scientific and technical knowledge during this century has created the problem of its timely access and retrieval. Frank pointed out that computer technology has played a significant role in facilitating access to such information. For example, a number of information services routinely monitor the literature on foods and nutrition, ab­ stract it, and disseminate it in machine-readable form. Frank described several of the available food and nutrition computerized data bases and information resources that researchers seeking information about foods and human nutrition should consider. They were classified into three types: 1.

Bibliographic data bases consist of citations of published journal articles, audiovisual materials, and books. The author listed and described several examples of these resources whose major emphasis is on food and nutrition, including: AGRICULTURAL ONLINE ACCESS, COMMONWEALTH AGRICULTURAL BUREAUX ABSTRACTS, FOOD SCIENCE AND TECHNOLOGY ABSTRACT, and FOODS ADLIBRA. Other data base sources with in-depth coverage of selected food and nutri­ tion areas were listed and described.

Management Information Systems

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2.

Referral data bases describe current research going on in the United States. One such service is the USDA's CURRENT RESEARCH IN­ FORMATION SERVICE. It reports on research in progress, conducted or sponsored by the USDA, related to several areas, including foods and nutrition.

3.

Numeric data bases are primarily concerned with numbers and codes that cite statistical data or other forms of information. The author described three of these. One, the USDA NUTRIENT DATA BANK, gathers and tabulates nutrient data and has been doing so for decades. Another, the USDA NATIONWIDE FOOD CONSUMPTION SURVEY, is the main federal tool for gathering and maintaining data on the food intake of individuals and households. The third numeric data base described, the HEALTH AND NUTRITION EXAMINATION SURVEY (HANES) program, was established to measure the nutritional status of Americans and to monitor changes in their status over time. All three data bases are available in printed and machine-readable form. In fact, all of the referral and biblio­ graphic data Frank described may be accessed and searched online through a number of avail­ able information service vendors, the number of which is rapidly expanding. Costs for such services vary according to connect-time, tele­ communication costs, and other factors. For examples, copies of actual documents may be ordered online and obtained from far-awy specialized libraries for a fee.

Finally, Frank listed a number of organizational resources useful in locating information that cannot be easily found elsewhere, such as the NATIONAL RE­ FERRAL CENTER OF THE LIBRARY OF CONGRESS (whose service is free), trade associations, universities, private industry, and special interest groups. Item 79 relates to this topic.

68

74.

Management Hoover, Loretta W., and Michael S. Leonard. "Automated Hospital Information System Functions for Dietetics." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 80 (April 1982): 312-316. Rapid expansion of the use of management infor­ mation systems in health care facilities prompted the authors to conduct a mail survey among vendors of automated systems and hospitals, using them to identify the functions automated in these facilities. In their report the authors summarized the prevalence and availability of applications for dietetics re­ ported as components of automated hospital informa­ tion systems. Vendor responses were analyzed to identify those providing packages supporting infor­ mation management for eight functions in dietary de­ partments. The functions included menu planning, meal scheduling, food selection for purchasing, charge capturing, production reports, stores inventory, diet change notification, and nutrient analysis (see glos­ sary) . The two most frequently used automated die­ tetic functions in hospitals were charge capturing and diet change notification. Findings from this survey confirmed that there was a growing acceptance of computer applications in dietetics in health care facilities. Hoover and Leonard predicted that, because of increased availa­ bility of automated hospital information system com­ ponents in dietetics, such systems would be increas­ ingly adopted by more institutions regardless of their size. The results of this survey documented the growth and acceptance of automated hospital in­ formation systems for dietetic departments over the previous decade.

75.

Manchester, Katharine E., and Jane F. Sager. "The Proposed Army Hospital Food Service Data Processing System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIA­ TION 56 (February 1970): 114-117. The United States Army sought the assistance of computer technology for its hospitals' dietary op­ erations in 1969. It set forth a proposal for de­ veloping a hospital food service data processing system that was to have two components. The first

Management Information Systems

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consisted of computing support services such as hard­ ware, programs and related procedures. The second was a food service system that was amenable to com­ puter support. The purpose of the proposal was to develop a computer-assisted management system that would: (a) realize cost savings in food service operations, (b) improve patient care and enhance satisfaction by performing computerized functions not possible manu­ ally, and (c) utilize the services of the profes­ sional dietitian more effectively. The developers of the proposal reasoned that the speed and mathematical accuracy of computer-generated data, which could be produced and updated quickly, would free dietitians to carry out more professional responsibilities. The computerized system would facilitate delivery of better food with a higher nutritive value and con­ currently improve the quality of care provided to the patients.

76.

Matthews, M.E., and J.P. Norback. "A New Approach to the Design of Information Systems for Foodservice Management in Care Facilities." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 84 (June 1984): 675681. An organizational framework is presented for inte­ grating food service data into an information system to facilitate management decision-making. The design of the framework was based on applications of prin­ ciples derived from the disciplines of accounting, managerial economics, mathematics, information science, and computer science. Steps involved in the design were described: (a) conceptualizing a food service system from an input-output perspective; (b) suggesting methods, from the management accounting literature, to assign costs of using resources within a food service operation; and (c) proposing a matrix data structure to illustrate the type of information that would be made available for management planning and control. The authors stated that it was unquestionable that the development and use of computer technology and information systems to assist in managerial decision­

70

Management making would expand throughout the 1980s and 1990s. Questions were raised concerning the magnitude of the increase and the role institutions that serve the dietetics community, such as The American Die­ tetic Association, colleges, universities, and business interests would play to bridge gaps between re­ search, education, and practice. This implied that successful progress towards the design, development, implementation, and evaluation of advanced computerbased dietetics information systems will depend upon progress made towards the transfer of relevant knowl­ edge generated through research, disseminated through professional education, and translated into practice.

77.

Pearson, Thomas E. "Computer Systems in Healthcare: A Glimpse of the Future and the Role of a Resource Center." ANNUAL JOURNAL OF DIETETIC SOFTWARE (1986— 1987): 9-10. Increasing demands for operational efficiency and, in some cases profitability, has prompted some healthcare food service administrators to consider computerbased systems. One problem is that administrators cannot be expected to know all of the available hard­ ware and software options. Also, many of the problems that follow installation of computer systems cannot be foreseen. In order to assist in the software selection process, features of a current, sound software system are described. Such features are based on the con­ cept of an "operator-sensitive" software package which the potential purchaser should expect to find in the following categories. CATEGORIES Ingredient files Inventory management Recipe control Menu planning Forecasting Production control Purchasing assistance Point of sale support Base for nutrition counseling Catering planning and control

Management Information Systems

71

"To the minute" business reports Menu engineering support Optional recipe files ATTRACTIVENESS FEATURES Driven by menu format for easy operator use Utilizes a common language to facilitate linking Works with one data entry point with cross refer­ encing to all subsystems automatically completed Handles multiple operations (sites) Interfaces with all other hospital systems easily, including: Room assignment and control Housekeeping Nurses station records Succinct While "operator-sensitive" systems offer potential benefit to healthcare institutions, four areas of concern for educators/researchers and those involved in the total management of institutional facilities were identified. These included (a) interfacing concerns, (b) software concerns, (c) staff training concerns, and (d) general management concerns. To address these concerns the Hotel, Restaurant and Institutional Management Computer Resource Center was established at Purdue University as a neutral resource which could serve the industry. The role of the Center is described. Services provided re­ volve around demonstration activities, evaluations, training, development of systems, and question serv­ ice .

78.

Schaum, Kathleen D., and Joan L. Sharp. "PatientOriented Dietetic Information System. I. A Com­ puterized Menu Print and Diet Order System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 63 (July 1973): 35-38. For years, dietetic researchers from The Ohio State University Hospitals at Columbus worked on the computerization of dietetic procedures. They de­ veloped and implemented a system that generated physician diet orders, patient census data, birthday

72

Management cake needs, menus sent on patients' trays, informa­ tion as to which patients’ nutrient intakes needed to be calculated, and personalized computer-printed menus. The goals of the computerization project were twofold: (a) to eliminate hand-written diet order Kardexes so as to improve the legibility and accuracy of patients’ diet orders, and (b) to provide the means for printing individual patient menus cor­ responding to the diet order. The authors claimed that the system was developed to add sophistication to hospital dietetic procedures It saved some time, yet its principal advantages were its improved legibility and accuracy. The authors affirmed that the development and implementation of the patient-oriented dietetic information system took a great deal of time, money, and effort.

79.

Sze, Melanie C. "Meeting the Information Needs of Food Scientists Through Computerized Literature Searching. FOOD TECHNOLOGY 36 (October 1981): 92-97. Computerized literature searches can assist in meeting the information needs of the food and nutri­ tion professions. In addition to explaining how to conduct a literature search, the author described various sources of relevant information and how to access them via computers. She stressed that com­ puter-based searches covering all facets of a subject could be conducted in a relatively short period of time. For example, searches could be conducted to investigate scientific nutrition concepts, the economic significance of a given food item, and food production and consumption patterns. Sze affirmed that the data bases or various in­ formation retrieval services encompassed every area of intellectual and professional endeavor. Further­ more, she suggested that one could find any published information sought quickly and precisely by accessing these data files using computer terminals. The author summed up her paper by stating that more in­ formation is available through a computer terminal than through any library in the world. The computer had become a useful research tool.

Management Information Systems

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No longer was the use of computers limited to number crunching. A vast amount of information is now available on virtually any topic. The computer’s role in the education of nutrition professionals is increasing. Item 72 expands on this topic.

Computer Applications

80.

Bassham, S., and L.R. Fletcher. "A Review of Computing in U.K. Dietetics." ANNUAL JOURNAL OF DIETETIC SOFTWARE (1986-1987): 4-5. Computers have revolutionized the work of UK nutritionists and dietitians. The UK situation is reviewed chronologically. In the early days mainframe computers were used for nutrient analysis. Progress was made when interactive analytical pro­ cedures emerged. Shortly thereafter there was a transition from mainframes to microcomputers. In all phases of the evolution of computers in the discipline in the UK, nutrient analysis and dietary assessment applications prevailed. The authors compared the growth of computers in the US and UK. They noted two differences. First, in the US there is a lot more software available for catering (food service systems) than in the UK. Secondly, there is far more software available in the US than in the UK. Finally, three other predominant British applica­ tions were described. These were (a) nutritional support, assessment, and prescription, (b) use of pocket computers to assist in calculating a patient’s nutritional support needs, and (c) software to cal­ culate intravenous regimens. It was noted that dietitians have been slow to realize the potential of computers in their work due to a lack of understand­ ing and training in this area.

81.

Clithero, Wendell A. "The Computer as a Dietetic Tool." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 44 (1964): 451-452.

74

Management Clithero, representing the International Business Machines Corporation, Data Processing Division in Chicago, spoke of how the advent of high-speed com­ puters and the principles that governed their opera­ tions could be applied to the problems of human nutrition. He cautioned that using computer tech­ niques most effectively would require the expertise of those familiar with the problems at hand. In this case the dietitians were urged to study the overall concept of the technique, to define the nature of the problem, to furnish accurate data (input), and to interpret the computer’s solution to the problem (output). In his closing remarks, the author called for a "universal coding system” to catalog data on individual food items and their nutritive values in order to take advantage of the enormous filing and organizational capacity of computers.

82.

Danford, Darla E. "Computer Applications to Medical Nutrition Problems." JOURNAL OF PARENTERAL AND ENTERAL NUTRITION 5 (October 1981): 441-446. Popularization of microcomputer-assisted dietary analysis software in the early 1980s prompted their widespread use. At the same time, nutrition pro­ fessionals began to express a number of concerns re­ lated to their use. These originated from the wide range of results obtained from the routine processing of diet records with computers. Surprisingly, these variances were found despite the common source of most nutrient data— the United States Department of Agriculture. Danford described an interactive computer-assisted program that also avoided the need for time-consuming coding procedures. The major objective of this pro­ gram was to yield a cost-effective and reliable sys­ tem that would require minimal professional time and effort to enter the data. It was successfully im­ plemented at an outpatient clinic where dietary intake information was entered into the computer. An im­ mediate printout of the diet analysis was generated and used for consultation with the patient prior to a physical examination. Such information became part of the patient’s medical record. It was also dis­ cussed at team conferences which, in itself, was a

Management Information Systems

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significant contribution to better patient care. Dietary data collected on each patient could be stored and retrieved at a later date to generate profiles of a patient's nutrient intake over time or to conduct statistical analyses of groups. Fin­ ally, the system was amenable to modification and expansion in anticipation of advances in computer technology. Danford was one of the first researchers to com­ pare the results of analyzing a single day's diet, using eleven commonly used computerized data bases. The author demonstrated the wide range of differences that may result with processing diet records using different data bases. A surprising finding consider­ ing that all the data bases studied had a common origin. Wide variability in the results obtained from computer-assisted diet analysis systems caused great concern for a number of reasons. For one, computer­ ized diet analyses created the mystique that they were more accurate than they actually were. Thus, they gained unwarranted credibility. In fact, many systems contained poor data bases, were difficult to use, and lacked flexibility. Consequently, nutrient calculations derived from one-day menus differed considerably depending on the system used. Addi­ tionally, since different data bases yielded varying results, concern was expressed over the effects of interpreting the output of such programs on public health. Many researchers conceded that the causes for variability were difficult to pinpoint. There­ fore, inter-system variability influenced the accuracy and validity of dietary analyses. As a result, a body of literature emerged. These are summarized in items 77, 91, 93, 98, 105, 106, and 107.

83.

Hoover, Loretta W. COMPUTERS IN NUTRITION, DIETETICS AND FOODSERVICE MANAGEMENT: A BIBLIOGRAPHY. 2 ed. Columbia, Missouri: The Curators of the University of Missouri, 1983. This 42-page bibliography cites references that have appeared in the periodical literature since 1958 dealing with computer applications in nutrition,

76

Management dietetics and food service management. It was pre­ pared to provide a single source identifying refer­ ences in these areas. The bibliography includes applications in health care, human nutrition, busi­ ness, industry, and college and school food service. Arranged chronologically, the bibliography depicts the evolution and development of the literature in this area. Citations are arranged alphabetically by year. A system of codes is used to assist research­ ers in locating information of interest.

84.

Hoover, Loretta W. "Computers in Dietetics: The State of the Art, 1976." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 68 (January 1976): 39-42. A thorough review of the literature points to the technological feasibility of using computers to analyze diets, manage food service systems, care for patients, educate nutritionists and dietitians, and carry out research. The capabilities of com­ puter technology are underutilized in dietetics. However, the use of computers in the discipline is expected to expand beyond those described in this state-of-the-art report. The report describes contemporary uses of data bases, nutritional and patient care applications, and food management applications. Predictions about future applications are made. Among the areas where further research is expected are cost accounting, labor productivity, facility layout and design, pro­ duction forecasting, scheduling, and patient educa­ tion. Hoover states that educators had already begun to modify their curricula in order to integrate computer applications. Furthermore, competencies related to computer applications were anticipated for both ad­ ministrative and clinical dietitians. Unlimited opportunities to advance the use of computers in dietetics can only come about through the efforts of creative and technically competent dietitians.

Management Information Systems 85.

77

Maloff, Tania, and Hilda Zears. COMPUTERS IN NUTRITION. Dedham, Massachusetts: Artech House. 1979. A landmark book relating nutrition to computers. For the first time the discipline had a single bound source to refer to for enlightenment on the use of computers. In addition to covering basic computer concepts, man-machine interface, and programming languages such as FORTRAN, the book dealt with other topics. These included diet analysis, data bases, patient histories, menu planning, and an assortment of administrative and computer applications in nutri­ tion education. The book possesses many strengths that make it worthwhile reading for those interested in the com­ puterization of the profession. One is its pioneer­ ing broadness and coverage of computer applications across the discipline. Another is that it is lucidly written and amply illustrated. Moreover, it offers speculations about future applications and notes areas in need of further research. However, the book was published just at the brink of the microcomputer revo­ lution. Consequently, it received only passing notice In any case, the book sheds little light on procedural guidelines for the effective design, development, im­ plementation, and evaluation of a computer-based cur­ riculum in the discipline within the context of higher education. Furthermore, it does not suggest ways for the profession to integrate computers into their daily professional practice. Despite these shortcomings, the depth and breadth of the book promote much thought and appreciation of the problems faced by the profes­ sion as it strives to computerize its operation. Thus the profession entered the 1980s with a textbook from which to teach computers.

86.

Orta, John. "Computer Applications for the Foods and Nutrition Professions: The State of the Art." KNOWLEDGE, TECHNOLOGY, AND FAMILY CHANGE. Yearbook 4. Thompson, Patricia J., Ed. Bloomington, Illinois: Bennet & McKnight, 1984, 111-124. The history of computer applications in the foods and nutrition professions between 1960 and 1983 is

78

Management surveyed and linked to nutrition education. Past uses of the computer are described in the areas of foods, food service systems, normal nutrition, and clinical nutrition. Advanced computer applications in the discipline are proposed. These include computer-assisted instruction enhanced with computer graphics, computer-based learn­ ing systems for the home, integrated technologies involving computers and video interfaces, optical character reader (OCR) technology applied to nutrition education, and data base access via personal computers and telecommunications systems. Creativity and a willingness by the profession to harness and exploit the technology to serve humankind, through expanded nutritional applications of the computer are, accord­ ing to the author, major contemporary challenges of the foods and nutrition professions.

87.

Rochford, Connie C. "Inquiry into Computer Applications in Dietetics." JOURNAL OF THE AMERICAN DIETETIC DITETIC ASSOCIATION 66 (April 1975): 374-375. Around the mid 1970s nutritionists were pondering the feasibility of implementing one or more data processing applications in dietetics in their depart­ ments. It was evident that there were major questions that needed to be addressed. Rochford proposed a three-pronged approach: (a) a review of the litera­ ture on existing computer applications in dietetics, (b) determination of benefits to be derived from the acquisition of computing capabilities, and (c) deter­ mination of whether the computer system could be optimized and expanded to enhance patient care if the costs were justified. Based on an assessment of the factors outlined, Rochford concluded that a dietary department would be ready to select those computing tools that would yield increased effectiveness in the total nutritional care of patients. Rochford's article pointed to the lack of experience and procedures for implementing computer applications in dietary departments in the mid 1970s.

Management Information Systems

88.

79

Sorenson, Ann W . , Raymond Seltser, and Bonita Wyse. "Personal Computers for Health." THE PROFESSIONAL NUTRITIONIST 15 (Winter 1983): 1-6. Widespread accessibility to personal microcom­ puters by both professionals and the general public led some leaders of the profession to express concerns over the potential misuse of the medium. For example, the authors reasoned that while personal computers were powerful delivery systems to convey health edu­ cation, they were susceptible to misuse by opportun­ ists and quasi-health practitioners. What prompted Sorensen and colleagues to take such a position? One factor was the abundance of lowquality software available on the market. In an at­ tempt to meet heightened market demands for software created by the proliferation of desktop computers, a lot of poor software had been placed on the market. Many available programs were designed with a weak or incorrect theoretical base. These originated from a flourishing cottage industry of basement programmers who were undoubtedly good at programming computers but somewhat less skilled in the techniques of health and nutrition education. Therefore, in an environment prompted by entrepreneurial zeal, software developed for mass consumption had to be appealing. Some nu­ tritional analysis programs met such demands by in­ cluding controversial nutrients in their data bases. These developments created concerns over the public health implications of generating recommendations on nutrient intakes on the basis of inferior data bases. Moreover, the authors reported that many professionals lacked the expertise to judge the accuracy, sources, and capabilities of existing computerized data bases. Yet, the most vulnerable aspect of computer-mediated health and nutrition education was thought to be the public's inability to interpret the data provided. A number of remedies were suggested to address these concerns. One was that the profession should set up some sort of accrediting system to ensure the standardization, accuracy, and credibility of food composition data contained in computer nutrient anal­ yses systems. The authors cited the annual Nutrient Data Bank Conference, which over the years had

80

Management expanded its scope of discussions to include topics dealing with data bases and comparison of dietetics and nutrition software, in addition to being a clear­ inghouse for sharing and selling such systems. In sum, the authors concluded that lay, as well as pro­ fessional, people should have access to ready-to-use, reliable, and credible programs appropriate for their intended tasks. Citations echoing similar concerns are found in items 94, 105, and 178.

89.

Willard, Robin. "Computers in Dietetics." CURRENTS 9 (May-June 1982): 1-14.

DIETETIC

Progress towards institutionalization of management information systems in dietetics led to the develop­ ment of strategies to design, develop, implement, and evaluate such systems. Willard concluded that most dietitians are ill-equipped to select a computer sys­ tem. Therefore, she outlined and commented on a tested eight-phase systems development approach that would provide dietitians unfamiliar with computers with a basis for proceeding with the project. To illustrate the approach, the author described an actual case study. Willard also presented several pros and cons on whether to develop or to buy a system. Since the design, development, implementation, and evaluation of a computer-based dietetic information system represents a considerable investment, Willard recommended the creation of a development team con­ sisting of personnel from dietetics, data processing, and administration to enhance its effectiveness. Moreover, the author stressed the importance of docu­ mentation following each phase of development, while emphasizing the significance of obtaining input by all those to be affected by the proposed system. In sum­ mary, Willard advocated that dietitians prepare for the impact that computers will continue to exert on the practice of dietetics.

90.

Williams, C.S., and L.W. Burnet. "Future Applications of the Microcomputer in Dietetics." HUMAN NUTRITION: APPLIED NUTRITION 38A (1984): 99-109. These experts predict a rapid expansion of micro­

Management Information Systems

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computer applications in dietetics. Specific areas cited include education and training, patient inter­ viewing and counseling, information storage, and administrative and research applications. Advances in computer technology, particularly in applications relevant to the discipline, will further widen the gap. Therefore, it is recognized that entry-level nutrition professionals are ill-equipped to use com­ puters as a professional tool. In order to narrow the gap between education and practice, immediate steps must be taken to systematically integrate com­ puter applications across the nutrition and dietetics curriculum.

91.

Wheeler, Lawrence A., and Madelyn Wheeler. ’’Review of Microcomputer Nutrient Analysis and Menu Planning Programs.” M.D. COMPUTING 1 (1984): 42-51. Researchers tested and compared seven commercially available microcomputer nutrient analysis and menu planning programs. The programs tested varied greatly in their capabilities and costs. The authors recom­ mended that prospective users review the software that they were considering with the results of their com­ parisons .

92.

Youngwirth, Joni. "The Evolution of Computers in Dietetics: A Review.” JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 82 (January 1983): 62-67. A broad overview of the significant accomplish­ ments in the use of computer technology in nutrition and dietetics is presented. Following a brief his­ torical perspective, computer applications in the major areas of the discipline are described. These include applications in (a) food service, (b) clini­ cal dietetics, (c) instruction, (d) continuing educa­ tion, (e) dietary administration, and (f) planning for computer-based operations. The article cites many important references which makes it an excellent starting point for further research in the area. As a result, the work is widely quoted in related arti­ cles because it is an up-to-date (1983) assessment of computer applications in the discipline, published in the profession's most widely read journal. Item 86

82

Management describes a relevant state of the art report.

Nutrient Analysis Systems and Data Bases

93.

Adelman, Merril 0., Johanna T. Dwyer, Margo Woods, Ellen Bohn, and C.L. Otradovec. ’’Computerized Dietary Analysis Systems: A Comparative View." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 83 (October 1983): 421-429. Three dietary analysis systems were studied and their characteristics compared. Diets were analyzed for 10 subjects— 5 omnivores and 5 vegetarians. Re­ sults were compared. Software, its contents, data base maintenance, procedures, and costs differed from one system to the next. Calculation of 3-day food records differed from one system to the next. Sig­ nificant differences were noted for energy and several nutrients. The authors urged continued use and im­ provement of comparative studies in order to clearly define reasonable degrees of variation between com­ puterized data bases.

94.

Anderson, Jennifer E., and Coerene M. Jansen. "Support Materials for Nutrient Analysis Programs." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 72. In response to the problems associated with the general public’s inability to interpret the output of computer nutritional analysis programs, the authors discuss the development of resources to help lay people submit and correctly interpret the output of such programs. They explained that the content of these resources should vary with their purpose and design. Furthermore, they stated that the format of support resources should depend on both the program’s intended message and educational setting. With these points in mind nutrition educators need to consider those factors that should be included in order to simply and concisely explain a program’s output to the' user. The authors concluded that well-developed sup­ port materials can facilitate understanding of the output of nutritional analysis programs. Similar

Nutrient Analysis Systems

83

lines of thought are expressed in items 88, 105, and 178.

95.

Farris, Rosanne, Gail C. Frank, Larry S. Webber, and Gerald Berenson. "Quality Controls for Processing Dietary Data." JOURNAL OF DIETETIC SOFTWARE 1 (Fall 1984): 3-4. A number of variables account for differences in the results of computerized nutritional analysis calculations. It is important, for the sake of ac­ curacy and validity, to establish procedures to assist in the elimination of inconsistencies and human error in the process of evaluating diet records. Farris et al., researchers from the Specialized Center of Research-Arteriosclerosis (SCOR-A) at the Louisiana State University Medical Center, reported on the Center's ten-year experience collecting 24-hour die­ tary recalls. They were used to relate reported intakes of dietary components of children to risk factor variables of coronary heart disease. The authors described a standardized system of quality controls that had been developed for use in the ongoing Bogalusa Heart Study. It included com­ puter programs to check codes, calculate gram weight from model amounts, edit extreme values, and summar­ ize data output. The authors stated that computer technology applied to internal quality control pro­ cedures remained an area for study. Moreover, ad­ vances in this area would improve the quality of dietary research data and warranted further consid­ eration.

96.

Hemmen, Theresa E. "Computer Nutrition Services: A Guide to Selection." JOURNAL OF DIETETIC SOFTWARE 2 (Winter 1985): 7-8. Hemmen developed a simple checklist enumerating an assortment of factors to consider when evaluating computerized nutritional analysis vendor services. These were divided into four categories (a) general list of factors related to software, hardware, and system capabilities, (b) items related to the input and output of data, (c) questions examining the

84

Management features of the analysis generated, and (d) features related to the format and content of the printouts.

97.

Hepburn, Frank N. "The U.S.D.A. National Nutrient Data Bank." THE AMERICAN JOURNAL OF CLINICAL NUTRITION 35 (May 1982): 1297-1301. The rapid expansion of information about the nu­ tritional composition of foods, both in terms of the total number of foods and their corresponding nutrient values, created a need for computerized procedures to store and handle such large volumes of data. This was due to various reasons, including a heightened inte­ rest in the nutrient content of foods, regulations governing nutrition labeling, the emergence of novel food products on the market, and the development of new food processing and preparation techniques. As a result, a depository of food composition information was created called the National Nutrient Data Bank (NDB). It is operated and maintained by the United States Department of Agriculturefs Consumer Nutrition Center. Hepburn described several of the important serv­ ices that the NDB provides. It issues and revises AGRICULTURAL HANDBOOK NO. 8, which consists of food composition tables used by dietetic professionals to evaluate the nutritional adequacy of menus, diets, and food records. The accumulation and processing of food composition data is an ongoing concern. The NDB produces six computerized data bases. These are available from the National Technical In­ formation Service. Evidently there is a great deal of computerized nutrient data available and its volume is growing. Nevertheless, this proliferation has created a number of concerns among nutrition profes­ sionals. For one, in the absence of nutrient infor­ mation on some foods, imputed values are often used to fill in blank spaces. These are average nutrient values obtained from several food analysis determina­ tions. The use of imputed values has led to concern over the nutrient data bases’ reliability, validity, and most of all, their comparability— an issue which will be discussed at length in the following sections.

Nutrient Analysis Systems

85

Hepburn stated that future uses of computerized data bases will require the ability to identify the vintage of the data base used for the sake of com­ parability. Moreover, nutritionists should be aware that the growth of knowledge concerning the composi­ tion of foods improves the accuracy of the known data. Therefore, the author suggested that any discussion of the status of nutrient composition data should consider the quantity and quality of the data since there exist strengths and weaknesses associated with all food composition information. Hepburn cited a number of reasons why this is so. First, differences between the known and generated knowledge on the nutrient content of various foods usually reflects the degree of interest in specific nutrients. Similarly, food industry-derived food composition data is generated in response to regula­ tory requirements placed on foods bearing nutrition labels. Consequently, food-industry nutrient infor­ mation is available only for a limited number of nu­ trients. Secondly, the scientific literature often describes nutrient values for foods of expressed in­ terest to the nutrition community. However, the status of the analytical methodology used to determine nutrient levels also exerted some influence over which nutrients would be determined from a set of foods. Hepburn described the status of various procedures and concluded that many yielded either conflicting or fragmentary information, and some were not developed at all. In sum, since the NDB collection is constantly changing, the profession needs a way to vouch for the accuracy of the nutrient data it used to analyze for the nutrient content of foods. In response to this concern, Hepburn described three developments under way that would lead to im­ proved knowledge and verification of the accuracy of nutrient data bases. These included (a) more syste­ matic generation of nutrient data, (b) improved data handling and processing procedures, and (c) applica­ tion of computerized data base information to food consumption survey applications, including diagnostic tools to check computerized systems for common errors and operational deficiencies.

86

98.

Management

Hoover, Loretta W. "Computerized Nutrient Data Bases: I. Comparison of Nutrient Analysis Systems." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (May 1983): 501-505. The results of three successive analyses of a common dietary record was compared. Each set of analyses involved refinements in order to minimize differences in the results of the computations. Despite refinements, considerable variability con­ tinued to exist after the third round of analyses. This demonstrated the need for assuring the relia­ bility and validity of computerized dietary analysis systems which led to the development of a model to appraise the capabilities of computerized nutrient data base systems (items 101 and 102).

99.

Hoover, Loretta W . , and Betty P. Perloff. "Computer­ ized Nutrient Data Bases: II. Development of Model for Appraisal of Nutrient Data Base System Capabili­ ties." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (May 1983): 506-508. The first version of the MODEL FOR THE REVIEW OF NUTRIENT DATA BASE CAPABILITIES (item 101) was tested with seven nutrient data base systems. The authors claimed that the model proved to be a capable tool for assessing their accuracy and capabilities. They developers and users of nutrient data base systems to use or adapt this systematic methodology to appraise the performance and capabilities of their systems. The model was a major contribution since heretofore no such systematic procedure had existed.

100. Hoover, Loretta W . , Richard P. Dowdy, and Karla V. Hughes. "Consequences of Utilizing Reduced Nutrient Data Bases for Estimating Dietary Adequacy." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (March 1985): 297-307. Periodically, the United States Department of Agriculture (USDA) conducts a Nationwide Food Con­ sumption Survey of Individuals (NFCS). The effects of using a small nutrient data base versus a large data base in evaluating dietary survey data is ex­ amined. The USDA data base (NDB) used in the 1977-

Nutrient Analysis Systems

87

1978 NFCS included values for energy and 14 other nutrients for 4,404 food items. It was systematically reduced to a data base of 396 and 200 food items re­ spectively. Both data bases were used to recompute 3-day dietary records collected on 7,914 individuals, for calories and 14 nutrients for 22 sex-age groups. The degree of variation between the use of the large and small data base was determined using a statis­ tical analysis of variance. Significant alterations and interactions resulted between NDB type and var­ ious sex-age groups due to reduction of the NDB. Nonetheless, the degree of difference between the calculated nutrient levels using the original and reduced data bases was quite small. The 1-year-old sex-age group was an exception, however. Based on this study, the authors concluded that reduced data bases could be used to predict nutritional adequacy for the NFCS, since results obtained from use of the original large nutrient data base showed the same trends. A number of lessons were learned from this study, namely, that professionals involved in the selection of a nutrient data base should consider the eating patterns of the target population to be studied to determine whether a reduced data base would be suit­ able. A summary of information about frequently consumed foods by the group in question may be useful in identifying foods that should be included in the data base. Also, several considerations were out­ lined for determining the size of a nutrient data base. These included (a) the intended purpose for which the data base would be used, (b) the nutrients of concern, (c) the food consumption patterns of the target group, (d) and desired versatility. Both ad­ vantages and disadvantages of using reduced nutrient data bases were described. The idea of reducing nutrient data bases to eval­ uate diets more efficiently suggested that they could be adapted to study the diets of specific populations. For example, an "all-American" data base may exclude ethnic, regional, and seasonal foods which may limit its utility for appraising the nutritional status of specific populations. Conversely, developing well-

88

Management defined data bases has the potential for yielding more precise assessments of a specific group’s dietary pat­ terns. By extension, a more specific data base may serve as a better instructional tool for nutrition education for the population concerned.

101.

Hoover, Loretta, W., and Betty P. Perloff. MODEL FOR THE REVIEW OF NUTRIENT DATA BASE SYSTEM CAPABILITIES. Columbia, Missouri: The Curators of the University of Missouri. 1981. Since microcomputers proliferated in the early 1980s, the number of available commercial nutritional analysis software packages have grown. In order to evaluate the flood of new analytical software it be­ came necessary to systematize the process. In response to this need, Hoover and Perloff developed a system to evaluate a computerized data base and a system’s performance and capabilities. It was called MODEL FOR REVIEW OF NUTRIENT DATA BASE CAPABILITIES. The model consisted of two parts. The first was a questionnaire designed to identify the features of a nutritional analysis software package. It contained questions related to the source(s) of nutrient data, characteristics of the nutrient data base, features of the software, system availability, and required facil­ ities . The second part of the model was designed to yield information about the performance and capabilities of the system itself. It described five tasks to be per­ formed, including (a) data base update, to validate the updating process; (b) calculation of nutrients for a recipe, to validate the system’s recipe calcula­ tion’s procedures; (c) reporting baseline data, to evaluate the data base status with respect to several food groups; (d) reporting nutrients for various portion sizes, to validate the adjustment of units stored in the nutrient data base; and (e) dietary record computation, to validate a program’s computa­ tions. Additionally, worksheets and interpretation guides were provided along with the model to facilitate the review process. In sum, the model enabled users to systematically appraise some contents of nutrient data bases and computational methods of nutritional

Nutrient Analysis Systems

89

analysis software. The model was updated in 1984 (item 102).

102.

Hoover, Loretta W . , and Betty P. Perloff. MODEL FOR THE REVIEW OF NUTRIENT DATA BASE SYSTEM CAPABILITIES. 2d ed. Columbia, Missouri: The Curators of the University of Missouri. 1984. The second edition of the model (item 101) was revised and updated in three ways:

103.

1.

Ham, as a food item, was changed throughout the tasks and interpretation guide to sep­ arable lean without a specification for the type of cure.

2.

Interpretation guides for dairy products were updated to reflect iron values released in 1982.

3.

Revised data from AGRICULTURE HANDBOOK 8, sections 8, 9, 10, 11, and 12 were incorpo­ rated into the interpretation guide.

Johnson, R.L., R. Selzer, D.H. Blankenhorn, S.P. Azen, et al. "Nutrient Analysis System— A Computerized Seven-Day Food Record System." JOURNAL OF THE AMERI­ CAN DIETETIC ASSOCIATION 83 (December 1983): 667-671. Over the years a number of computerized procedures for analyzing diets have evolved. Each had idiosyn­ crasies that made it stand out in one way or another. Researchers from the University of Southern California School of Medicine developed a novel approach, which they called, the Nutrient Analysis System (NAS). It consisted of a seven-day, self-recording, directly computer-readable system. An individual’s food consumption pattern was ana­ lyzed on the basis of self-recorded responses on a set of nine data cards used for each day analyzed. The first card was used to identify the patient. The remaining eight cards showed foods from nine repre­ sentative food groups. There were approximately 860 food variations among the nine data cards. Blank

90

Management spaces on each card allowed subjects to mark the amounts consumed. Provisions were made so that re­ spondents could record foods eaten that were not on the data cards. The nutrient data base used to esti­ mate the nutrient content of the diets was the Na­ tional Heart, Lung, and Blood Institute data bank. When completed data cards were processed, the NAS system generated a printout summarizing weekly nu­ trient intakes. The researchers listed several of the unique features of the NAS. First, since the system allowed for self-recording in a computer-readable format, it saved professional time. The time saved was spent on more beneficial counseling activities. Second, draw­ ings of food portions on the cards were based on standardized food models. They increased the accuracy of the estimates of quantities consumed. Third, the NAS cards were designed to remind respondents of food preparation techniques, which largely infleunce the nutrient content of a diet. Fourth, immediate feed­ back allowed for more relevant individual counseling. Notwithstanding, the researchers conceded that the use of the NAS system required more training time to use than the traditional method of written food records. The degree of accuracy obtained from analyses us­ ing the NAS system was found acceptable. The authors concluded that the NAS was a viable method for col­ lecting seven-day nutrient intake data. The NAS inspires more advanced applications of the technology. Were the system configured to include a video output display of different foods, rather than drawings on data cards, and its video-based foods library expandable, it would facilitate a more ac­ curate and perhaps more comprehensive picture of an individual's food intake. Integrated computer-video interfaces involving videodiscs (or similar tech­ nology) and well-designed computer-based questioning strategies, could yield the most accurate and useful picture of diet patterns possible. Availability of more precise analytical procedures will lead to more effective counseling and diet therapy since the exact nutritional obstacles to improved health would become more evident.

Nutrient Analysis Systems 104.

91

Randall, Elizabeth. ’’Regionalizing a National Nutrient Data Base." JOURNAL OF DIETETIC SOFTWARE 2 (Winter 1935): 6-7. Randall was one of the first to conceptualize the idea of regionalizing a nutrient data base. She con­ cluded that a nationwide, so-called "representative” data base was insensitive to regional differences in dietary composition. The author questioned the extent to which the uniformity built into the national nu­ trient data base masked actual regional and seasonal differences in nutrient intakes. The importance of the question was highlighted by the fact that the re­ sults of national food consumption surveys, which are derived from extensive use of the USDA Nutrient Data Base, are used in the design of the nation's health and nutrition food-related policies. This issue was the incentive which led Randall and colleagues to undertake the development of a Texas regional nutrient data base. Additionally, these re­ searchers found further need for their efforts in order to support their research at the Texas Medical Center because of the state's geographic and ethnic diversity. Randall described the systematic steps that a small group of foods and nutrition professionals undertook to develop the Texas data base. Among these were (a) the determination of serving sizes appropriate to the region, (b) identification of important foods used by residents, and (c) calcula­ tion of nutrient values from recipes commonly con­ sumed in Texas. At the time this work was reported, the researchers were at the point of contacting re­ gional food specialists in order to systematically collect recipe data on a statewide basis. Also, ac­ cording to the author, the nutrient data base was still in the developmental stages requiring time, money, and endurance. Randall affirmed that although there was a movement to standardize nutrient data bases, there remained a need to make changes, using sound scientific procedures, to reconcile regional differences in food consumption patterns.

92 105.

Management Rogan, Anne and Stella Yu. "Some Problems with Nutri­ tional Analysis Software." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 65-66. Some of the potential serious problems associated with nutritional analysis software are described. These include (a) potential misuse by pseudo-nutri­ tionists, (b) inappropriate use of nutrient data by legitimate professionals, and (c) interpretation of the printouts of the nutritional analysis programs. The authors expressed concern over potential forms of "nutritional quackery" that could result when unscrupulous entrepreneurs use computers to exploit consumers. An example was cited describing how non-traditionally trained "nutrition consultants" could use such programs to document the need for their products and services. Specifically, if a client's diet analysis were to exhibit micronutrient shortcomings, supplements to remedy the problem could be recommended— even though one dietary analysis may not be representative of a person's usual intake. The second problem area associated with analytic software was related to professional usage. Legiti­ mate professionals may convey a false sense of pre­ cision by using computer-generated printouts to edu­ cate their patients. Many are unaware of the wide variability of nutrient data that exists for similar food items. Also, the practice of listing nutrient values to the hundredth or thousanths of a milligram was found to be inconsistent with state-of-the-art chemical analyses used to determine nutrient levels in foods. In most nutritional anlaysis software programs the burden of interpretation falls on the user. Per­ sons who are not trained in the nuances of the Recom­ mended Dietary Allowances, for example, may be misled by the output of some programs. In fact, the authors stated that it was difficult, even for a professional, to make definitive statements about a person's die­ tary intake on the basis of a nutritional analysis of one or several meals. The authors concluded that nutrition educators needed to learn more about the potential benefits and

Nutrient Analysis Systems

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pitfalls of computerized nutritional analysis pro­ cedures. They noted that the ultimate goal of the profession should be to promote the development of nutritional analysis software packages that would serve as useful tools with sound educational objec­ tives. Citations expressing similar concerns can be found in items 88, 94, and 178.

106.

Shanklin, David, Jeannette M. Endres, and Marjorie Sawicki. "A Comparative Study of Two Nutrient Data Bases." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (March 1985): 308-313. Dietary intakes reported for 18 infants, 22 young children, and 20 women were analyzed using two dif­ ferent computerized nutrient data bases and results were compared. Significant differences were found in the calculations of several nutrients from the diets analyzed. Also, the nutrient composition of many common food items found in the two data base systems were different. This was so despite the systems’ shared data sources. The authors conclude that in order to resolve differences among computerized nu­ trient data base systems will require comprehensive reviews of all data base systems. Also, they called for the establishment of a national nutrient data base to serve as a standard.

107.

Taylor, Martha L., Betty W. Kozlowski, and Marion T. Baer. "Energy and Nutrient Values from Different Computerized Data Bases." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 85 (September 1985): 1136-1138. Twenty-four diet records were analyzed using three unidentified computerized nutrient data bases. Com­ parability of values derived from each were assessed. Differences in mean values were found for 9 of 19 nutrient variables evaluated. No one data base con­ sistently yielded highest or lowest values for all nutrients. Among the data bases, mean values were found to be most consistent for the energy-yielding nutrients, and three minerals. Even when there was no significant difference in mean values, there were wide variations in the values for some individual diets. It was reasoned that values derived from

94

Management computerized nutrient data base systems should be considered as estimates. Likewise, their strengths and limitations should be recognized.

108.

Windham, Carol T. "USDA's Nutrient Data Bank." & NUTRITION NEWS 58 (November/December 1986):

FOOD 33-34.

The Nutrient Data Research Branch of the Human Nutrition Information Service (HNIS), USDA operates the National Nutrient Data Bank (NDB), a computerbased management system which stores nutrient data and descriptive information about the data. Data values are collected from many sources including government laboratories, university researchers, and the food industry. Sampling techniques, analytical methodologies, and replication procedures are used by the USDA to ensure the statistical validity of values incorporated into USDA released data. Selected USDA food and nutrient data sets are presented in tabular form. Several nutrient data sources are described. AGRICULTURE HANDBOOK NO. 8 is the standard published nutrient data reference. Whereas the USDA NUTRIENT DATA BASE (NDB) FOR STAN­ DARD REFERENCE is the corresponding machine-readable data set. Four recently released computerized data sets are listed and described including: 1.

USDA NUTRIENT DATA BASE FOR INDIVIDUAL FOOD INTAKE SURVEYS, Release 2,

2.

THE PRIMARY NUTRIENT DATA SET FOR USDA NATIONWIDE FOOD CONSUMPTION SURVEY, Release 1,

3.

THE USDA TABLE OF RETENTION FACTORS, Release 1,

4.

RECIPE FILE FOR RELEASE 2 OF THE USDA DATA BASE FOR INDIVIDUAL FOOD INTAKE SURVEYS.

Nutritional Analysis Systems

95

Software Selection

109.

Byrd-Bredbenner, Carol, and Suzanne Pelican. "Software: How Do You Choose?" JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 77-79. In order to facilitate software selection pro­ cedures, Byrd-Bredbenner and Pelican developed two standardized instruments. The first was designed specifically to judge nutrition education software, whereas the second was designed to evaluate nutri­ tional analysis software. The instrument designed to judge nutrition educa­ tion software included items designed to appraise the characteristics and educational qualities of the soft­ ware. The instrument included questions related to the program’s goals and objectives, its intended tar­ get audience, and the educational methodology employed to achieve learning goals such as drill and practice, tutorial, or simulations. In order to further assist in judging the educational quality of instructional software, questions were included to ascertain content accuracy, organization, ease of use, ease of error correction, efficiency of the medium, and whether ob­ jectives were adequately met. Questions related to the software’s documentation were also included in the instrument. These were intended to determine their content accuracy, completeness, audience-appro­ priateness, value in support of the software, and its overall technical quality. On the other hand, the instrument described to assist in reviewing nutritional analysis software in­ cluded questions on the software’s characteristics, input procedures, program output, documentation, estimates of operating times, and overall evaluation. These comprehensive instruments were used as evaluation guidelines in judging approximately 50 programs by nutritionists. The reviews were published in the spring of 1984 special edition of the JOURNAL OF NUTRITION EDUCATION, which was devoted to computers in nutrition education. The development of these in­ struments was a significant milestone since such comprehensive and standardized guidelines, useful for

96

Management appraising software, had not been published to date.

110.

Frank, Gail C., and Suzanne Pelican. ’’Guidelines for Selecting a Dietary Analysis System." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 86 (January 1986): 72-75. Increased sophistication of professional tasks in dietetics by the mid 1980s warranted equally sophis­ ticated software selection strategies. The authors developed a model worksheet to simultaneously evaluate important characteristics of nutritional analysis software and match these areas of professional re­ sponsibilities . Software characteristics included aspects related to the nutrient data base, program operation, systems output, and system integrity. On the other hand, areas of professional responsibilities were classified as clinical, metabolic/experimental, epidemiological, administrative, or educational. To illustrate what each area of responsibility entailed, Frank and Pelican described sample tasks associated with each area. For example, for clinical tasks, responsibili­ ties involved analysis of patient intake against therapeutic standards, whereas those involved with education were charged with producing easy-to-understand profiles of dietary data. The software selection process called for the use of the worksheets to match software characteristics with appropriate areas of professional responsibili­ ties. Once relevant variables were matched, nutri­ tionists would then be able to proceed and search for the appropriate software. The authors referred read­ ers to the JOURNAL OF DIETETIC SOFTWARE, the NUTRIENT DATA BANK DIRECTORY, the DIRECTORY OF FOOD AND NUTRI­ TION INFORMATION SERVICES AND RESOURCES, and the spring 1984 computer theme issue of the JOURNAL OF NUTRITION EDUCATION. Guidelines set forth by Frank and Pelican, using a worksheet format, were different from any pre­ viously described in the literature. They were de­ signed to match the tools with the tasks of the re­ quired job. Consequently, once a thorough search of

Nutritional Analysis Systems

97

available software was completed, dietitians would have a more precise idea of which software would best suit their needs. Precise identification of needs would facilitate software selection procedures and strengthen the conviction that a correct choice was made. Additionally, dietitians would become in­ creasingly proficient at evaluating and selecting software in the face of every-changing professional needs.

111.

Sager, R.A. ’’The Software Search: A Dilemma." OF DIETETIC SOFTWARE 3 (Winter 1986): 8-9.

JOURNAL

In order to facilitate nutrition software acquisi­ tion, information on 246 food and nutrition software packages was compiled using a microcomputer data base management system. Once the data is stored it takes very little time to retrieve information on any given program. However, the author noted that the immense time required to generate this data base may initially affect any benefit realized by the developer. Also, the future utility of the data base requires constant research to guarantee reasonably current reference listings. An analysis of characteristics, trends and pat­ terns related to the software information collected is presented. Characteristics analyzed include cost, hardware compatibility, intended audience/users, and program topics. Topical categories were ranked ac­ cording to their frequency.

112.

Slavin, Joanne L., Anita Wilson, and Dawn Willey. "Take the Proper 'Byte’ when Selecting Microcomputer Nutrient Analysis Software." FOOD TECHNOLOGY 39 (April 1985): 74, 76-77. In order to assist in the selection of nutritional analysis software, an evaluation guide for nutrient data bases is presented. Eight popular nutrient analysis programs for the microcomputer are compared on the basis of number of food items, number of nu­ trients, and hardware requirements. Potential pitfalls of computerized dietary analysis systems are cited.

98 113.

Management Taub-Dix, Bonnie. "Choosing a Computerized Nutrient Analysis." ENVIRONMENTAL NUTRITION 8 (November 1985)

1- 2 . A concise and useful checklist of questions to guide in the selection of computerized nutrient an­ alysis software is presented.

CHAPTER V FOOD SERVICE OPERATIONS

INTRODUCTION

Over the years numerous computer applications related to food service management have emerged. These include the generic functions of the area, including menu planning, purchasing, receiving and storage, production and processing, food delivery and service systems, layout and design of food service facilities, equipment design and selection, sanita­ tion, and energy.

GENERAL REFERENCES

114.

Anonymous. "Computerized Fortune-Tellers Forecast the Future of Food Service." INSTITUTIONS 87 (August 1980): 30-31. What if a reduction in the Arab oil supply to the United States prompted a rise in the price of gaso­ line to $2.50 per gallon? What impact would it have on the cost and availability of foods and other es­ sential supplies to health care facilities? Insti­ tutions Magazine reported on sophisticated computer­ ized econometric models that allowed food service operations to explore similar "what if" scenarios in order to plan for the future. 1980 was the year that the first econometric fore­ casting models for the food service industry were 99

100

Food Service Operations developed. The work was accomplished by a firm called Chase Econometrics which was under contract with the National Restaurant Association. Computers’ ability to handle large amounts of mathematical data make them suitable for weighing the myriad of vari­ ables that go into complex forecasting decisions. One was programmed to consider variables affecting food service management. Since then, some members of the commercial segment of the food service indus­ try began to use econometric modeling to project sales and profits. The system's sophistication en­ abled decision makers to weigh various considerations before embarking on new ventures. The authors pre­ dicted that computer-based econometric models would gain increasing importance in all segments of food service management in the future.

115.

Beach, Elizabeth, Mary Lynn Vassar, and Karen McCracken. "Implementing a Comprehensive Foodservice Computer System." JOURNAL OF DIETETIC SOFTWARE 3 (Winter 1986): 10-11. Computerization of the food service department at the Willis-Knighton Medical Center in Shreveport, Louisiana was considered essential to the development of intradepartmental systems and procedures in order to effectively control food costs while maintaining a high level of quality food standards. Steps involved in implementing the system are described. Relevant issues addressed are hardware, nutrient data base cross-referencing with the actual inventory, recipes, menus, menu calendar, ingredient room, purchasing system, and nutritional analysis. Implementation of the computerized system improved control measures in all production, inventory and purchasing areas. Additionally, the nutritional analysis component of the system enhanced patient nutrition education.

116.

Fowler, Karen D. "Evaluating Foodservice Software: A Suggested Approach." JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 86 (September 1986): 1224-1227. Advances in the technology have increased the

General References

101

elaborateness and expense of food service management software. This creates a major source of concern among professionals. Consequently, systematic pro­ cedures for evaluating and selecting appropriate food service software are warranted. In response to such a need, Fowler suggested an approach to assist managers and nutritionists. The steps involved in the evaluative process include (a) listing goals, (b) assessing needs, (c) assigning weights to desired attributes, (d) developing a checklist of vendors, (e) eliminating inappropriate systems from considera­ tion after a survey of vendors, (f) developing re­ quest for proposals from selected vendors, (g) ana­ lyzing returned proposals, and (h) selecting the ap­ propriate system(s) for implementation.

117.

Kasavana, Michael L. COMPUTER SYSTEMS FOR FOODSERVICE OPERATIONS. New York: Van Nostrand Reinhold Company. 1984. Expansion of computer technology in the food service industry created a need for professionals with knowledge of computers. Professor Kasavana published a book to assist in teaching computer sys­ tems in food service operations. The text covered food service information systems, data processing concepts, computer operating systems, cash register concepts and configurations, automated payroll sys­ tems, precosting systems, menu engineering, back office systems, and beverage control systems. At the beginning of each chapter, the major objectives were listed. Moreover, the text had an excellent glossary. The publication of this book was a major step towards educating food service professionals on the use of computers in their field. It was well or­ ganized and illustrated, and therefore suitable for teaching the subject to a college audience.

118.

McCool, Audrey C. "Computer Technology in Institu­ tional Foodservice." JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 86 (January 1986): 48-56. Researchers at the University of Maryland’s

102

Food Service Operations Department of Nutrition and Institutional Management investigated the use of computer technology in in­ stitutional food service. They conducted a survey with the fourfold purpose of determining (a) the characteristics of facilities using computers, (b) the types of computers used, (c) a profile of the typical food service manager using computers, and (d) the purpose of the computer applications used by food service managers. The results of their study showed that educa­ tional institutions were by far the biggest users of computer technology, followed by hospitals and extended-care facilities. Mainframe computers were the most widely used, whereas microcomputers were a distant second. Users were most likely to be men employed on a full-time basis in their institutions. They gener­ ally held a bachelor's degree, although many held a master's degree. The study showed that the courses the managers had taken influenced their utilization of computer technology. That is, those who had taken a minimum of six or more business management courses were the most likely to use computers. The survey listed five types of applications by functional areas: (a) menu-related functions, (b) purchasing and storage functions, (c) production functions, (d) client services, and (e) management information functions. The researchers found that all functions were used by at least one of the in­ stitutions surveyed. The authors presented two tables to summarize their findings, one describing computer applications by size and the other by type of food service. Throughout the study the authors found a strong and direct relationship between in­ stitutional size and computer use. In short, larger institutions were more likely to use computers than smaller ones. The study illustrated both the growth of computer technology in food service over the previous three decades and the need to modify the dietetics curricu­ lum to train future professionals in the daily use of computers.

General References 119.

103

Pellegrino, Thomas W. SELECTING A COMPUTER-ASSISTED SYSTEM FOR FOOD SERVICE. Chicago, Illinois: Ameri­ can Hospital Publishing, Inc. 1986. This book is a comprehensive guide to selecting, implementing, and evaluating a computer-assisted system for volume food service. It consisted of eight phases: 1.

Defining the needs based on the existing system

2.

Evaluating system problems and solutions

3.

Defining the requirements of the computer system

4.

Conducting a feasibility study

5.

Preparing for vendors' proposals

6.

System selection

7.

Planning for implementation

8.

Implementing and evaluating the new system

The guide served as a comprehensive document on the subject. It was supplemented with a case study illustrating each phase. Additionally, charts, fig­ ures, examples, and useful appendices enhanced the contents of the text. In sum, the guidelines outlined a practical approach, heretofore unavailable, for those seriously considering implementing a computerassisted system in their food service operation.

120.

Sawyer, Carol A. "Computers in Food Service." FOOD SERVICE RESEARCH REVIEW 10 (Fall 1986):

SCHOOL 128-135.

This bibliography summarizes selected publications related to computer applications in the management of food service systems. The bibliography includes ci­ tations of published materials organized under the following headings: 1.

History of computers in food service

104

Food Service Operations 2.

Applications for computers in hospital, military, restaurant, school and university food service management

3.

Operational aspects of using computers in food service

4.

Educational strategies for computer-assisted instruction, and

5.

Computerized nutritional analysis applicable to food service operations

MENU PLANNING

121.

Anderson, Ann L., Aimee N. Moore, and Loretta W. Hoover. "Development of an Automated Form Generating System for Menu Item Data." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 71 (August 1977): 124-128. A computer-assisted system was designed and tested to generate forms that were part of a production con­ trol sub-system in the Department of Nutrition and Dietetics, at the University of Missouri-Columbia Medical Center. The researchers' objectives were to develop a computer-assisted methodology to generate a master menu, along with food production forecast and usage forms, production worksheets, food order reports, and master copies of selective menus for regular, calorie-restricted, and sodium-restricted diets. It took approximately six months to study the appropriate programming language, analyze the exist­ ing manual system, design the new system, collect and code menu data, develop six computer programs, and test them. When the programs were initially tested, a 30 per cent reduction in time was realized over conventional methods. The authors predicted that greater time reductions would result once the system was fully implemented as a component of a computer-assisted production control sub-system at the Medical Center. Anticipated benefits of the new system were (a) ease of making menu changes when

Menu Planning

105

desired, (b) automated production of updated docu­ ments, (c) significant reduction of errors, and (d) virtual elimination of storage of hard-copy docu­ ments since they would be generated as required. The Automated Form Generating System was fully tested and approved for implementation at the Medical Center

122.

Balintfy, Joseph L. "Menu Planning by Computer." COMMUNICATIONS OF THE ACM 7 (April 1964): 255-259. This is one of the earliest reports on menu plan­ ning by computer. A computer program was developed which planned menus by determining the minimum cost combination of menu items so that daily dietary, gas­ tronomic, and production requirements could be satis­ fied for a sequence of days. Balintfy described a special algorithm which approximated the theoretical solution to the problem. The system allowed for menu changes online if necessary. It was estimated that a 30% savings on food costs could be achieved upon implementation of the system.

123.

Bergalia, Joseph S., and Joan E. Pope. "Computerized Menu Printing System Reduces Clerical Tasks." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 51 (September 1977): 185-188. A computerized menu printing system adopted by a hospital’s dietary department in Houston, Texas is described. Since their previous diet order and menu printing system was found to be cumbersome and timeconsuming, the food service department decided to switch to a computer-based menu order system in order to meet its needs. Each day the computer-generated (a) individualized menus for patients, (b) a dietary checklist for in­ dividual nursing units, and (c) a list of those pa­ tients who had received a menu and their room numbers Files were updated daily. All of this was possible because of the computer's ability to store large amounts of information without increasing clerical time. The computerized system was credited with saving

106

Food Service Operations an estimated $15,000 annually. This was accomplished through a reduction of clerical work and the elimina­ tion of three positions. The authors reported that dietary clerks, who had previously devoted a sub­ stantial amount of time to writing patients’ names and room numbers on menus, were assigned to clerical tasks that dietitians had previously been performing. This additional benefit enabled dietitians to pursue their jobs more professionally by allowing them more time for assessing the nutritional status of patients, recommending nutritional care, counseling patients, and interacting with physicians.

124.

Chandler, Sarah J., L. Charnette Norton, Loretta W. Hoover, Aimee N. Moore. "Analysis of Meal Census Patterns for Forecasting Menu Item Demand." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 80 (April 1982): 317-323. Since 1970 researchers at the University of Missouri-Columbia (UMC) Health Science Center’s De­ partment of Nutrition and Dietetics have devoted a significant part of their research efforts to de­ velop a statistical computer-assisted forecasting system. The major objective of the research described in this report was to identify the best set of data to use in forecasting food production requirements for meals served to patients in each of three daily meal periods. A second objective was to determine the re­ lationship between patient census at meal periods and the midnight census. This research was undertaken as part of an effort to develop representative data bases considered essential to the success of a forecasting system. Computers were used to carry out the projects since electronic data processing aids in management of large volumes of data facilitating the forecasting process.

125.

Ford, Margaret G., and Neil W. Wesley. "Dietitians Improve Patient Care with Computerized Selective Menu." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 53 (March 1, 1979): 76-79. Ford, a clinical nutritionist, and Wesley, a systems analyst working at Fairview General Hospital,

Menu Planning

107

a 541-bed acute care hospital in Cleveland, Ohio, described a computer-based selective menu system they had developed. The computer-based system was designed to: (a) provide each patient with a selec­ tive menu, (b) ensure that diet prescriptions would be accurately filled, (c) enable dietitians to work more professionally to improve the nutritional care of patients, (d) ensure that all patients receive direct attention from the dietitians, and (e) reduce food, printing, and personnel costs. The automation of the dietary department’s pro­ cedures replaced the daily clerical, menu-related, decision-making process that was part of the dieti­ tian's typical workday. Furthermore, it enabled patients to select menus more aligned with their per­ sonal preferences, yet within the constraints of their diet presciption. It was therefore assumed that increased satisfaction with the diet would pro­ mote its consumption, which would, in turn, enhance the patients’ health status. Several other advantages were cited that were attributed to the computerization of the system. Menus generated by the computer, for example, could also serve as teaching tools. They could be used to instruct patients on which foods were allowed and which were not allowed in their prescribed diets. Because the computer-based system freed clinical dietitians from food service-related tasks, they would have more time available for assessing nutri­ tional status, developing nutritional care plans, counseling and teaching nutrition. It was noted that the development of such a sys­ tem required rapport and cooperation between the hospital’s data processing department and the foods and nutrition services’ staff members, because de­ velopment of the system depended on the knowledge contributed by the nutrition staff to the systems analyst. His assigned tasks were to understand the dietitians' activities and to formulate a system to facilitate their computerization. As the systems analyst became more acquainted with the dietitians' area of responsibility, he would be able to suggest further refinements and applications, resulting in the generation of reports useful for auditing

108

Food Service Operations

departmental activities. Finally, cost savings were reported. These were achieved primarily through accurate production of acceptable foods based on patients' preferences. Additionally, computer-printed menus yielded sub­ stantial cost savings in terms of supplies and cler­ ical and supervisory personnel. It was projected that the system would save $32,700 annually.

126.

Hoover, Loretta W., A.L. Waller, A. Rastkar, and V. Johnson. "Development of On-Line Real-Time Menu Management System." JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 80 (January 1982): 46-52. A computer-based menu management system is de­ scribed. It was developed as a module of the inte­ grated computer-assisted food management system that had been in place for several years at the University of Missouri-Columbia Health Sciences Center, Depart­ ment of Nutrition and Dietetics. The upgraded sys­ tem supplanted the previous form-generating system and allowed for more flexibility in menu design. The Master Menu File was the major data base in the system. It was updated using real-time processing, which permitted easy and timely updating of the menu matrix. The file contained data about each occur­ rence of menu items and was interfaced with recipe files to generate numerous printed documents. Menus were displayed on a video terminal. They are avail­ able online at all times for reference by supervisors and dietitians. A number of benefits were attributed to the up­ graded system. Among them were its flexibility and the elimination of certain clerical tasks. For ex­ ample, entering new menu items required only a brief amount of time, and revised documents related to the new menus were generated on the same day. These in­ cluded the master menu, nutrient syllabi, menu audits, and food production forms such as forecasts and usage sheets. The authors predicted that the Master Menu File would be utilized more fully in the future following the design of modules that would effectively

Menu Planning

109

interface with the menu management system. The file was designed to accommodate expansion of data as the system matured. For example, food production fore­ casting, patient menu printing, and individualized diet planning were three anticipated potential en­ hancements to the system.

127.

Lowder, William, and Carolyn Medill. "Punch Cards Simplify Selective Menus." THE MODERN HOSPITAL 90 (January 1958): 102, 104, 106. Lowder and Medill were one of the first to report on the application of computers to food service prob­ lems. They described a system that used coded punch cards with selective menus and therapeutic diets to speed up service to patients. The system allowed the kitchen staff to plan meals "so accurately" that wasted leftovers were said to be eliminated. Speed, electronic accuracy and economic factors resulting in better controls were cited as benefits of the punch card installation.

128.

Messersmith, Ann M . , Aimee N. Moore, and Loretta W. Hoover. "A Multi-Echelon Menu Item Forecasting Sys­ tem for Hospitals." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 72 (May 1978): 509-515. Researchers from the University of MissouriColumbia Medical Center reported on the design, development, and evaluation of a menu-item forecast­ ing system to be incorporated into a computerassisted hospital food service operation. The system generated statistical forecasts for hospitalized patients' menu-item selections several days prior to a designated meal service. The system considered three interdependent levels: (a) patient census forecasting, (b) estimates of diet category census, and (c) estimates of menu-item demand. The computerized statistical forecasting technique was compared to the conventional manual technique. Comparisons were based on cost values of forecast errors. The results demonstrated that computerized statistical forecasting techniques were 39 to 41 per­ cent below the error costs of manual forecasting

no

Food Service Operations techniques.

129.

Moore, Aimee, N., and Byrdine H. Tuthill. COMPUTERASSISTED FOOD MANAGEMENT SYSTEMS. Columbia, Missouri Technical Education Services. 1971. In 1969, a conference on computer-assisted food management systems was held at the Medical Center, University of Missouri-Columbia (UMC). Early com­ puter applications in dietetics and healthcare food service management were discussed, including (a) in­ ventory control systems, (b) food cost accounting systems, (c) development of a standardized recipe data file, (d) food production control systems, (e) menu planning by computer, (f) implementing computerassisted food management systems in large medical centers, and (g) implication of these changes for the education of dietitians. Since the mid 1960s, UMC has been a pioneer in designing, implementing and incorporating the use of computers into the administrative dietetics curricu­ lum. One reason was that the academic department en­ gaged in these activities had a faculty committed to the integration of computers into the food systems management curriculum. They were equally interested in seeing that these applications were adopted by dietetic services in large medical centers as well. This is supported by the number of dissertations, theses, projects, and publications that have emerged from the Department of Human Nutrition, Foods, and Food Systems Management at UMC. Secondly, the de­ partment has always had a staff of computer profes­ sionals and the hardware at their disposal to carry out developmental work in this area. Finally, the department was housed in the UMC Medical Center it­ self which made the development of the model perti­ nent to "real world" problems.

130.

Orser, Jean, and Mary Mutschler. "A Computer-Tallied Menu System." JOURNAL OF THE AMERICAN DIETETIC AS­ SOCIATION 67 (December 1975): 570-572. In view of the large number of patients with equally varied dietary needs and food preferences,

Menu Planning

111

an automated menu tallying system was developed to facilitate the process at the 1084-bed Massachusetts General Hospital. A committee, including members of the Dietary, Printing, and Computer Departments, planned a system that would provide the information needed. The computer was programmed to generate two kinds of production worksheets after tallying patients’ menu selections. One listed only items to be pre­ pared at specific work stations. For example, if a sandwich was on the menu, a printout was generated with the total number of sandwiches needed for the given meal. The second printout recapitulated all items on the menu. Printouts were generated in suf­ ficient amounts so that all units of the dietary de­ partment received a copy. Production totals for each work station were printed on both worksheets. A monthly and yearly summary of the diet census was produced on demand. The developers of the computerized technique stressed that the changeover from a manual to a com­ puter-based menu tally system necessitated the co­ operation of all departments involved in its formula­ tion and execution. Also, a well-planned and imple­ mented training program to familiarize the dietary and nursing staff of the new menu format was essen­ tial. Orser and Mutschler concluded that although the system was transferable to other hospitals, pros­ pective users must understand that considerable pro­ fessional time would be needed to plan and organize such a system.

131.

Wood, Steven D. "A Model for Statistical Forecasting of Menu Item Demand." JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 70 (March, 1977): 254-259. A methodology is proposed to facilitate food pro­ duction scheduling by using a timely and economical procedure to obtain and update predictions for menu item demand based on food preferences. The author reasoned that by reducing the disparity between food prepared and food consumed, productivity would in­ crease in food service systems. Furthermore, the author speculated that modern computing machinery,

112

Food Service Operations coupled with statistical techniques, could be used with readily available operational information to derive accurate forecasts with a minimal margin of of error. When the forecasting model was tested in a 500bed hospital in Madison, Wisconsin, dramatic im­ provement in forecasting accuracy was reported. Wood concluded that the computer-based method for fore­ casting menu item demand was superior to previous manual forecasting approaches. As a result of greater forecasting precision a substantial reduction in excess costs resulted, yielding higher productiv­ ity.

132.

Wilcox, Marianne M . , Aimee M. Moore, and Loretta W. Hoover. "Automated Purchasing: Forecasts to De­ termine Stock Levels and Print Orders." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 73 (October 1978): 400-405. The major objective of these researchers was to improve upon their ongoing inventory control sub­ system by optimizing inventory levels of frozen foods. This was accomplished by calculating the quantity of an order based on menu-item forecasts and existing stocks. The result was a computer­ generated printed requisition of the items needed. The procedure was integrated into the ongoing com­ puter-assisted food service management system used at the University of Missouri-Columbia Medical Center. The researchers described the system modification as an operational success. The implementation of the new system was success­ ful in several ways. For example, the revised pro­ cedure and computer-generated documents were well received by the personnel in the dietary department. The modifications were easily integrated into the daily operations of the department, as evidenced by how quickly and easily the system was adapted. All programs performed as planned. The computer-generated documents were accurate and complete. Following a two-week test of the new procedure, it was discovered that by implementing the new system such problems would not recur.

Receiving and Storage

113

RECEIVING AND STORAGE

133.

Johnson, Ruth A., and Aimee N. Moore. "Inventory and Cost Control by Computer." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 49 (November 1966): 413-417. Investigating electronic data processing tech­ niques applicable in dietetics, Johnson and Moore were one of the first to publish a methodology for computerized inventory and cost control procedures for use in hospital departments of dietetics. Two lessons were learned from Johnson and Moore’s study: (a) that it is essential for experts in dietetics to work closely with programmers in developing computer applications for the discipline, and (b) that a sys­ tematic approach is essential in developing computer applications if programs are expected to become available to the profession in relatively short order.

PRODUCTION AND PROCESSING

134.

Adams, Elaine A., and Ann M. Messersmith. "Robots in Food Systems: A Review and Assessment of Potential Uses." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 86 (April 1986): 476-480. In order to evaluate potential job functions for robots in the industry, a survey was conducted among management personnel in the food service, food pro­ cessing and food industry. Respondents were asked to assess 64 different food-related job functions relative to appropriateness for robotic implementa­ tion. In order to determine any positive or negative influence on job function, demographic data was col­ lected from each participatne. The responses were evaluated statistically. Sixteen out of the 64 job functions were found appropriate for robotic imple­ mentation for food industries by both food managers and robot manufacturers. The survey unearthed three major findings. First, there was mutual ignorance between food managers and robot manufacturers regarding what each did.

114

Food Service Operations Essentially, food managers are not familiar with the potential of robotics in food service and robot manufacturers lack knowledge of food service opera­ tions. Second, robots are not currently used ex­ tensively in the food industry. Third, the demo­ graphic analysis of the data relative to the 16 identified job functions showed no significant differences in responses.

135.

Guley, Helen M . , Simulation for Food System." ASSOCIATION 76

and Joel P. Stinson. "Computer Production Scheduling in a Ready JOURNAL OF THE AMERICAN DIETETIC (May 1980): 482-487.

Guley and Stinson of the College for Human De­ velopment and School of Management, Syracuse Univer­ sity, New York, used operations research techniques and computer simulations to schedule menu-item pro­ duction in a theoretical ready food system. Opera­ tions research, as defined by the authors, involves a number of methods and techniques applicable to solving a broad spectrum of problems, particularly quantitative business problems. A ready food system is one in which food is received either raw, semiprepared, or prepared, and subsequently processed into menu items. Such foods are then packaged into individual or bulk containers and refrigerated or frozen for future use. As in the cook/freeze system, food planning, production, and control are based on inventory stock levels rather than on the number of forecasted or requisitioned portions of specific menu items. Guley and Stinson's simulated model of a theoreti­ cal food production system was coded and executed on a computer. Given a set of constraints related to a food production unit, the computer generated produc­ tion schedules, which were then compared against designated performance criteria. This line of research demonstrated that computers were capable of assisting administrative dietitians in solving complex food production problems. With computer simulations that modelled ongoing food service systems, dietitians could input variables specific to their operations. Subsequently, the

Production and Processing

115

impact of one or more variables could be evaluated without any direct action on the existing system itself. Thus, several alternative strategies could be programmed into the computer and the best pattern for scheduling food production could then be selected by management. It was determined that the need to experiment with alternative scheduling patterns be­ came necessary to exclude those considered disrup­ tive to efficient production. These researchers re­ ported that their system made possible a significant number of simulations. In fact, in this study 3,000 days of operation were simulated incorporating rules governing efficient food processing techniques. Once again, the case was made on behalf of the computer's ability to simulate and thus facilitate decision­ making for administrative dietitians.

136.

Lambert, Carolyn U., and Betty L. Beach. "Computerized Scheduling for Cook/Freeze Food Production Plan." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 77 (August 1980): 174-178. Lambert and Beach of the Department of Food Science, Nutrition and Food Systems Administration, at the University of Tennessee, Knoxville, developed a computerized food production scheduling model. It was to be used to analyze food production plans for equipment and labor usage in a hypothetical cook/ freeze food production system. A cook/freeze food production system involves daily preparation of large quantities of foods. Once prepared, such foods are portioned, quickly frozen and stored for future serv­ ice. Food production in this manner is similar to a factory operation. Workers prepare foods and use equipment based on the inventory levels of prepared items. Unlike conventional hospital food production systems, which usually prepare and serve all menu items on the same day, cook/freeze systems do not. They permit Monday-through-Friday, nine-to-five pro­ duction and, conclude some food service administra­ tors, allow more efficient deployment of personnel and equipment. Lambert and Beach considered several relevant variables in developing the model: (a) the amount of food to be produced over a specific period of

116

Food Service Operations time, (b) types of foods to be included on the forecasted menu, (c) information on the particular food production system, and (d) data on the actual production activities, including labor and equipment demands. In sum, the computerized model furnished useful data to assist administrative dietitians in scheduling food production, personnel, and equipment in a hypothetical cook/freeze system. With such informa­ tion on hand, dietitians were better able to decide on how best to allocate resources and schedule food production, while minimizing the number of stated personnel skill levels needed in a food service facility. This innovative model promoted optimal use of available resources while minimizing food production costs. Although the researchers described how the model worked, no statement was made describing the computer or program(s) used to test the model. This report illustrated the need to bridge the gap between theoretical uses of computers in the discipline and their use by the profession at large.

137.

Snyder, Oscar P. "Computer-Managed Subsistence Sys­ tem: A Look at a Model Feeding System of the Fu­ ture." FOOD TECHNOLOGY 27 (March 1973): 42-48. At the 32nd Annual Meeting of the Institute of Food Technologists, Snyder outlined a model feeding system of the future. It was designed primarily for members of the armed forces and would be en­ tirely computer-based. Its purpose was to supply management with information with which to plan, op­ erate, control, and make decisions related to cost, customer satisfaction, and optimum nutrition. The overall goal of the system was to "optimize the nu­ tritional profile of the military consumer." Since the armed forces are buying the services of their personnel for 20 to 30 years, Snyder stressed that it was important to do whatever possible to keep such people in top physical and mental condi­ tion throughout their military career. He argued that the system was viable at the time since the

Production and Processing

117

hardware and software was already available. In short, Snyder emphasized that a computer-managed subsistence system would go a long way in optimizing the health of the military.

138.

Torrence, Barbara L., and Allene G. Vaden. "E.D.P. Recipe Adjustment by Percentage Method in a College Foodservice System." JOURNAL OF THE AMERICAN DIE­ TETIC ASSOCIATION 69 (October 1976): 407-411. Torrence and Vaden of the Department of Insti­ tutional Management at Kansas State University, Manhattan, worked on a project involving the use of computers to develop a food item file, a recipe file, and a food ordering system adapted to a uni­ versity residence hall food service system. Once the files and programs were developed by computer programmers working closely with systems dietitians, food orders for a seven-day period were printed. These printouts listed the number of pounds and order units needed. A space was allowed on the printout for an inventory adjustment column for modification of the suggested order amount based on the inventory on hand. The computer order requi­ sitions were printed in multiple copies for control and accounting purposes. Implementation of the system was completed during the 1975-76 academic year.

LAYOUT AND DESIGN

139.

Natta, Larry. "Computer-Assisted Drafting Makes its Mark in Foodservice." FOODSERVICE EQUIPMENT SPE­ CIALIST 36 (May 1983): 59-64. In recent years computer technology has been ap­ plied to the work drafting personnel used to do. In some instances computers have replaced drawing boards, T-squares, and special drawing pencils. Computer-assisted drafting (CAD) has come of age. Natta described how CAD was used to automate the design of food service facilities. He noted that

118

Food Service Operations producing drawings on CAD systems was about three times faster than conventional means, and revisions about twenty times faster. Natta reported that when a food service-oriented company combined CAD systems with computer-assisted manufacturing (CAM), it made a great leap into the future. The combination enabled the company to design custom fabrications for fabricators, but to produce them on computer tapes for use on computer­ ized sheet metal cutting machines. The author in­ dicated that one of the contributing factors enhanc­ ing the use of CAD-CAM in designing food service facilities was the requirement of the government’s General Services Administration that its contractors use CAD systems in preparing their proposals.

CHAPTER VI COMPUTER-BASED EDUCATION IN NUTRITION AND DIETETICS

INTRODUCTION

This chapter presents a meta-area, computerbased education in the foods and nutrition professions, which is set apart from the traditional fields of study in the typical undergraduate nutrition and dietetics curricu­ lum. It traces the relatively short history of computerusage for instruction in nutrition and dietetics. Its pur­ pose is twofold: first, to identify the variety of ways in which the computer has served instructional purposes in the discipline, and secondly, to assess the extent to which computers have been used in nutrition education. Areas where computer-based education has been applied to varying degrees are: (a) normal nutrition, (b) clinical nutrition, (c) community nutrition, (d) management, (e) food service operations, (f) food science, (g) elemen­ tary and secondary education, and (h) higher education.

GENERAL REFERENCES

140.

Breazeale, Steven P., and Sarah Fisher. "Selected Bibliography on Computers in Education." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 76C. Listed and described are some pertinent publica­ tions, periodicals, and articles dealing with

119

120

Computer-Based Education computer applications in education.

141.

McMurray, Pamela, and Loretta W. Hoover. "The Educa­ tional Uses of Computers: Hardware, Software, and Strategies." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 39-43. Educational uses of computers with an emphasis on the needs of nutrition educators are presented. His­ torical developments, trends, and strategies of past computer uses in education are described. Following a brief review of the history of com­ puters in education, the authors outlined several benefits of using computers in instruction, noting that computers (a) stimulated interest in learners, (b) were intrinsically motivating, (c) provide in­ dividualized instruction at the learner’s pace, (d) allowed immediate application of facts and provided feedback, (e) standardized the presentation of in­ formation, (f) simplified abstract information, (g) simulated experience, and (h) caused the learner to take an active role in the learning process. McMurray and Hoover also examined several of the considerations inherent in selecting and using com­ puter hardware and software systems in education. They made reference to the use of "authoring sys­ tems" by nutrition educators to design and write appropriate courseware. The use of these systems may be warranted in order to compensate for the lack of suitable nutrition courseware on the market. Relying heavily on Rushby’s (1979) classification scheme, the authors described four specific computerbased education paradigms: (a) instructional, (b) revelatory, (c) conjectural, and (d) emancipatory. Lastly, McMurray and Hoover discussed several pub­ lished reports describing the use of computers in nutrition education. Each represented an example of the paradigms proposed by Rushby’s taxonomy.

142.

Short, Sarah H., and William R. Short. "The Nutrition Message and the Medium." FOOD & NUTRITION NEWS 58 (November/December 1986): 29-32.

General References

121

It is argued that today’s nutrition professionals have at their disposal many communications and infor­ mation processing tools, which have emerged from various media and electronic technologies. These developments enable nutritionists to effectively reach individuals and vast audiences. However, media-wise charlatans are also aware of newer information tech­ nologies and make use of them to disseminate nutrition misinformation. Consequently, qualified nutrition professionals are challenged to select and use the ap­ propriate technology to disseminate nutrition infor­ mation to clients, patients, students, and the general public. Various technologies are described. Also, an ex­ cellent table presenting an overview of computer uses in the nutrition field is presented. The author urges the profession to take a lead in using the media and electronic technologies as educational and professional tools.

NORMAL NUTRITION

143.

Asp, Elaine, and Joan Gordon. "Development of a Com­ puter-Assisted Program for Undergraduate Instruc­ tion." JOURNAL OF NUTRITION EDUCATION Supplement No. 1 (1981): s91-s94. An interactive computer-assisted menu-planning program called MENU was described. It was inte­ grated into an undergraduate course in food deci­ sion-making to supplement lectures, reading, and written assignments. The authors outlined how the computer contributed to learning experiences in several stages of the process. During the first stage, basic knowledge was ac­ quired via lectures, assignments, and readings. During the second stage, the CAI program helped learners organize the newly acquired information and apply newly learned skills and facts. In the third stage, the computer contributed to the inte­ gration of facts into generalizations and concepts. A component that included menu planning simulations,

122

Computer-Based Education the fourth stage of the model, allowed learners to test the impact of their food choices on the nutri­ tional composition and sensory attributes of the revised menu. The researchers found that subjects in this study were able to make food choice decisions, but were not able to articulate the basis of their decisions. That is, these subjects were able to decide on foods for menus even though they had dif­ ficulty answering specific questions concerning basic facts. The study confirmed the idea that people tend to think about food holistically rather than in terms of discrete characteristics. Therefore, the authors concluded that these find­ ings had wide implications for the design of nutri­ tion education: Should the characteristics of the learning audience determine whether educators (a) teach basis details that form the basis of profes­ sional information, or (b) design unique programs capable of enhancing the existing decision-making skills of the learners? In any case, the computer did play a significant role in the above conclusion. Its flexibility allows a variety of instructional design paradigms suitable for individualization of nutrition education regardless of the choice.

144.

Carew, Lyndon B., David W. Elvin, Bethany A. Yon, and Frances A. Alster. MA College-Level, ComputerAssisted Course in Nutrition.” JOURNAL OF THE AMER­ ICAN DIETETIC ASSOCIATION 16 (June 1984): 46-50. The faculty of the Departments of Animal Sciences and Human Nutrition and Foods, and the Instructional Development Center of the University of Vermont in Burlington, developed a computer-assisted program to accompany a 15-week, college-level introductory lecture course on the fundamentals of mammalian nu­ trition. The CAI program was patterned after the professors' notes. It was conceived as an optional study resource. Students could use the program at their discretion. Many used it to revise and clar­ ify points made during the lectures, and to prepare for examinations. Additionally, the computer-based system gave the faculty the opportunity to appraise

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the usefulness of computer-based instruction. The CAI program was developed by a team consist­ ing of a nutrition professor, a computer programmer, and a technician who inputed the information into the computer. It took about 1,000 to 1,500 hours to develop the program which ran on a mainframe com­ puter. The text-based program contained eleven in­ structional files: 1.

Introduction and history

2.

Senses and appetite

3.

Digestion

4.

Carbohydrates

5.

Metabolism

6.

Lipids

7.

Proteins

8.

Energy

9.

Minerals

10.

Vitamins

11.

Water

In addition to statement and questions, the programs allowed students the opportunity to comment or to send messages to the instructor on any topic. A record-keeping feature was built into the system. Generically known as computer-managed instruction (CMI), the record-keeping system kept track of which students accessed the system, what files they used, and how long they were connected. It also recorded how each student answered each question, organized students1 comments, and analyzed patterns of re­ sponses to the various questions. Branching capabilities were incorporated into the instructional system, enabling capable students to proceed at their own pace to more advanced topics,

124____ Computer-Based Education and students in need of remediation to obtain it via referral to more elementary aspects of the subject. In evaluating their CAI system, the authors found that the majority of voluntary users considered it a very useful approach to learning. Most felt that the system had enabled them to improve their grades. In fact, analysis of the grades revealed that computer users as a whole had earned a higher final average score than non-users. Access and availability of time on the computer were cited as problems, espec­ ially with the use of mainframes for instruction. However, the researchers stated that the remedy was to adapt their CAI sequence for use microcomputers.

145.

Caster, W.O. "Computer Use for Nutrition Majors." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 76G. Caster developed an upper level, ten-week computer/ nutrition course for use by nutrition majors. It in­ volved the use of a mainframe and a series of micro­ computer programs. The author presented the outline of the course, which specified weekly topics and described the focus of lectures and laboratory ex­ periences. Topics included (a) nutrient evaluation of diets, (b) introduction to the computer language BASIC, (c) how to group individuals according to commonalities in their eating patterns, (d) adaptation of programs to field situations, and (e) institutional menu development and modification. At the conclusion of the course, students were expected to demonstrate their ability to operate the twelve computer programs with which they had worked during the term. Caster was one of the first to describe a complete undergraduate course for nutrition majors devoted to the use of nutritional analysis software. The report would have been more valuable if the authors had described in detail the rationale and motivation that led to the development of the course. More important­ ly, the author failed to discuss how well the course had run and how the students felt about it, and no mention was made of which areas were in need of im­ provement. The exclusion of significant topics, such as the major considerations involved in evaluating and selecting nutrient analysis software, suggested that there was room for improvement in the course.

Normal Nutrition 146.

125

Dennison, Darwin, Kathryn A. Frauenheim, and Leighton Izu. "The DINE Microcomputer Program: An Innovative Curriculum Approach." HEALTH EDUCATION 14 (April 1983): 44-47. The DINE (diet inventory of nutritional expe­ rience) microcomputer-based program is described. As in interactive program, the DINE is reported to be sophisticated enough for research purposes, yet simple enough for anyone to use. Its design in­ corporates sound health education and learning prin­ ciples. The DINE system has enjoyed wide use in schools, colleges, universities, and HMOs. Other applications include diabetic management, weight re­ duction, athletic training and cardiac rehabilitation. Physicians are the primary users of the program. The DINE system is recommended for use by health educators as a component of a basic nutrition course or in specialized courses with nutrition components: It is also adaptable to nutrition intervention pro­ grams. Although the system is easy to understand, the authors recommend its use with professional health practitioners to ensure that clients receive adequate follow-ups based on the nutritional findings.

147.

Ries, Carol P., and Julie Granell. "CAI in CollegeLevel Nutrition Education: A Feasibility Study." JOURNAL OF NUTRITION EDUCATION 17 (October 1985): 130-134. Ries and Granell of the Department of Foods and Nutrition, University of Illinois at Urbana, devel­ oped a college-level CAI lesson on the topic of vegetarianism. Since they thought that not enough research had been done on the effectiveness of CAI in nutrition education, they conducted a study to compare the effectiveness of their vegetarianism lesson with the traditional lecture/discussion method. The method used to describe the design and develop­ ment of the CAI lesson was described in a previous paper (item 149). Forty-four students who were enrolled in an in­ troductory foods and nutrition course were randomly designated to one of three groups: CAI treatment,

126

Computer-Based Education lecture/discussion treatment, or control student groups. All students were given a pretest and post­ test to measure their knowledge and interest in the subject matter. The researchers found no significant difference among the pre- or post-test knowledge or interest scores on vegetarianism. Furthermore, stu­ dents described their CAI experience as positive. The authors concluded that the results of their study reinforced previous research suggesting that CAI was a feasible alternative to the lecture/discussion method in the college nutrition classroom. They further suggested the need to develop more CAI for the nutrition curriculum since very few programs were available in the discipline. Their recommenda­ tions were based on the advantages they attributed to the medium over printed or audiovisual materials. These included its interactivity, its potential for delivering highly individualized instruction, and reduced costs associated with its revision and up­ date. However, the authors cautioned that the ini­ tial costs associated with the time invested to create CAI can be very high.

148.

Ries, Carol P., Julie Granell, and Paula Zemel. thoring a CAI Lesson in Nutrition Education." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 52.

’’Au­ 51-

While microcomputers have proliferated in number and sophistication, many professionals concede that software development has not kept pace. In the dis­ cipline of human nutrition, instructional software, or courseware, is still needed to teach many specific topics. Ries, et al. suggested that nutrition edu­ cators were ideally suited to address this need. The authors reasoned that as both subject matter ex­ perts and teachers, nutrition educators were capable of quickly, mastering CAI design techniques. The authors stated that the need for knowing how to pro­ gram a computer to design instruction was obviated by collaboration with an experienced programmer. Ries et al. described their development of a computer-based nutrition education lesson on the

Normal Nutrition

127

topic of vegetarianism. They used a plan developed by professor Esther Steinberg in her 1984 book en­ titled TEACHING COMPUTERS TO TEACH, which concen­ trated on lesson content and design. The authors explained the steps involved in pro­ ducing the computer-based instructional sequence. These included initial planning, selection of teach­ ing methods, planning interaction, writing text, formatting for optimal screen presentation, program­ ming, and evaluation. Additionally, the authors developed supplementary teaching materials and docu­ mentation for students to refer to. Ries et al. stated that, for practical reasons, the burden of programming was delegated to the pro­ grammer with whom they collaborated closely. How­ ever, this may not always be a practical approach. Programmers are expensive personnel. Their services are in high demand and it is unlikely that they would be readily available for working on time-consuming CAI projects. In the intervening years a number of authoring systems have emerged that obviate the need to work with a programmer. Authoring systems seem to be the most practical resource for motivated nutri­ tion educators to design and develop sophisticated computer-based instructional sequences and computermanaged instruction.

149.

Schaum, Kathleen D. "Patient-oriented Dietetic Infor­ mation System. 3. A Computer-Assisted Instruction Program for Calculating Nutrient Intakes." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 63 (August 1973) 154-156. Schaum reported on the development of a CAI pro­ gram for calculating nutrient intakes. The program was called "FOODS." Its purpose was to assist dieti­ tians, nurses, and medical personnel in learing to analyze the nutrient content of diets. The CAI pro­ gram consisted of four major parts: (a) a nutrient data base, (b) a teaching section, (c) a reference book, and (d) a computer program to allow the user to plan menus, retrieve nutrient data, and analyze dietary intakes based on the stored nutrient data base. The program was operational by 1973. It was

128

Computer-Based Education available to any institution that wanted to partici­ pate in the Ohio State Regional Medical Program CAI Study.

CLINICAL NUTRITION

150.

Argo, Jana K., Donna R. Watson, and Eugene C. Lee. "A Computer-Managed Instruction System Applied to Die­ tetic Education." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 79 (October 1981): 450-452. Argo, Watson, and Lee described their experience in implementing a system of computer-managed instruc­ tion (CMI) to support a course in the competencybased curriculum of the Dietetic Internship Program at Emory University in Atlanta. The course was re­ quired for all students entering the dietetic intern­ ship, designed to prepare students for their clinical experiences. Basic knowledge, attitudes, and skills related to the nutritional care of clients comprised the content of the course. Structured as a computer-managed instructional system, the course was divided into seven modules identified as Fundamentals of Clinical Nutrition: (a) interviewing techniques; (b) medical terminology; (c) modified diets; (d) the teaching-learning process; (e) the nutritional care process, emphasizing assess­ ment, planning, implementation, and evaluation; (f) documentation; and (g) session attendance. Argo et al. described several of the advantages and difficulties they had experienced using the com­ puter-managed system. Among the advantages was im­ mediate and constant feedback for instructors and students. Since instruction was team-based, indivi­ dual individual instructors were able to monitor each student's progress. Additionally, instructors were able to maintain direct control over the instructional process while freed from the clerical tasks associated with monitoring student progress. Increased free time allowed instructors more time for one-to-one inter­ actions with students, facilitating an individualized instructional approach. Another major benefit was

Clinical Nutrition

129

that the CMI was "content free," meaning that it could be incorporated across all disciplines, and thus cost-effective. Furthermore, a variety of evaluation strategies was feasible with the CMI sys­ tem, allowing a more objective approach to student evaluation. An offshoot of the management of student evaluative data was the CMI system's ability to gen­ erate learning prescriptions for each objective. These prescriptions advised students on steps to be taken to remove a deficiency. The system was capable of performing and producing a complete item analysis report on each student's progress. Finally, CMI was sufficiently flexible to be useful in both clinical and didactic courses. Difficulties were minor. Nonetheless, in the initial stages of development, instructors had to become used to the structure required to computerize instruction and evaluation. Those faculty accustomed to developing behavioral objectives and designing evaluation strategies prior to instruction adapted easily. Reliance on mark sense readers and the com­ puter for reporting the results of student performance was a minor problem. Finally, in the beginning of the course there were some problems with the operation of the equipment, resulting in delays in generating students' progress reports. All in all, the authors reported that the expe­ rience of using the CMI system was positive. It was well received by both students and faculty. Thus, computer usage in dietetic education had been success­ fully extended to include the management of instruc­ tion.

151.

Argo, Jana K., Donna R. Watson, Eugene C. Lee. "A Computer-Managed Clinical Evaluation System: Impli­ cations for Competency-Based Dietetic Education Pro­ grams." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 70 (April 1977): 382-384. Researchers from Emory University in Atlanta, Georgia described the process which they used to de­ velop and validate a computer-managed clinical eval­ uation system for implementation in the clinical component of their dietetic internship program. The

130

Computer-Based Education clinical portion of the internship lasts about eight months. During all phases of the clinical rotations, emphasis is placed on the assessment, planning, im­ plementation, and evaluation of nutritional care. Also stressed during training was student dietitians’ interaction with other members of the health team and patient education. The steps involved in developing the evaluation instrument included: (a) an analysis of validated performance criteria and competencies to identify ap­ propriate behaviors to measure in the clinical setting, (b) specification of the major areas to be evaluated, (c) specification of component areas within each major area, (d) specification of criteria for evaluation for each component behavior, and (e) definition of a rat­ ing scale. Validation of the instruments involved determina­ tion of content validity, inter-rater reliability, and practicality. Results of the trial evaluations indicated that the computer-managed evaluation system met the desired characteristics of validity, relia­ bility, and practicality. In addition, the system was well received by students, faculty, and clinical instructors. Finally, a number of important benefits were at­ tributed to the system: (a) the ease with which the evaluation forms were used in the clinical setting, (b) the immediacy of feedback available to both stu­ dents and faculty, and (c) most significantly, the instructors’ ability to monitor each student’s progress toward meeting those previously identified clinical competencies.

152.

Breese, Mary S., Ann C. Welch, and Frank Schimpfhauser. ’’Computer-Simulated Clinical Encounters: Development, Utilization, and Evaluation of a Program.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 70 (April 1977): 382-384. In order to provide quality clinical experiences in dietetics, it is necessary to place students in realistic clinical learning situations. In many col­ leges and universities in the United States, students

Clinical Nutrition

131

partake of clinical experiences in health care facil­ ities under professional supervision. However, faculty are not always assured that students placed in clinical situations will find patients that meet the specific learning requirements of the moment. Considering these factors, the faculty of the Division of Medical Dietetics at The Ohio State University, Columbus, developed and conducted a two-year pilot study to determine the effect of computerized clini­ cal simulations on dietetic students' total academic performance. The development, utilization, and eval­ uation of the program was reported by Breese, et al. Simulated patient-management cases had been used successfully in the past to develop problem-solving skills and to supplement the number and types of cases medical students would likely encounter during their training. In the same vein, the Ohio research­ ers developed simulations to supplement the clinical experiences of junior dietetics students enrolled in their coordinated undergraduate program. Development of the simulated nutritional-care case studies involved the faculty responsible for teaching the junior year courses in the coordinated undergrad­ uate program and a project staff. The staff included a project coordinator, clinical authors, an instruc­ tional programmer, a systems analyst, and a project evaluator. The cases presented patients exhibiting nutritional problems and diseases involving major body systems. These included the cardiovascular, endocrine, and gastrointestinal systems. Clinical instructors assigned simulated cases to students (just as they assigned patients for hospitalbased experiences). These were based on the didactic material being covered in the classroom and on the parallel clinical experience the student should have had in nutritional care management. Students were given one to two weeks to complete the assigned cases. When the student completed the work, it was submitted to the instructor for evaluation. A form was used by the instructor to evaluate the computer terminal­ generated printout containing all essential elements of comprehensive nutritional care. On a designated date, a post-computer clinical conference was held. Four to eight students and an instructor participated.

132

Computer-Based Education Each student had the opportunity to discuss his or her assigned case and the nutritional care problems presented in the simulations. Since not all students were assigned the same case, students had the oppor­ tunity to share and discuss their simulated case ex­ periences as a group. Findings from the two-year pilot study indicated that there was no significant difference in clinical performance and academic learning when students were provided with computer-simulated clinical encounters instead of hospital-based clinical experiences. Ad­ ditionally, there was strong evidence to suggest that there had been a marked enhancement of faculty monitor­ ing during the students' hospital-based clinical ex­ periences (to which less time was devoted). On the basis of these positive findings, it was decided that the computer-simulated clinical encounters would be integrated into the established curriculum of the co­ ordinated undergraduate program in medical dietetics at The Ohio State University. A sequel report is summarized in item 157.

153.

Ceterski, Dorothy, and Barbara North. "Analysis of a Microcomputer Program for Clinical Dietetics." JOUR­ NAL OF DIETETIC SOFTWARE 2 (Spring 1985): 3-4. The HEALTH-AIDE analytical software package is ex­ amined. The program was designed with three groups in mind: (a) individual interested in monitoring his own health and nutrition, (b) professionals involved in health assessment and nutritional analysis, and (c) educational institutions involved in nutrition education. Thirty-one senior and graduate-level students evaluated the software. The majority of students who participated in the evaluation of the program assessed it as an excellent educational tool. Moreover, it was concluded that the evaluation of the HEALTH-AIDE pack­ age demonstrated its accuracy and potential as a pro­ fessional nutrient analysis tool.

154.

Cotugna, Nancy, Ann M. Corrozi, and Clare Berrang. "Computerized Nutrition Counseling in a Coordinated

Clinical Nutrition

133

Undergraduate Program.” JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 82 (February 1983): 182-183. The Wellspring Project was designed to provide the University of Delaware, Newark community with current and accurate resources and materials to pro­ mote physical and emotional well-being. Since no direct nutrition services were available to the university community in the fall of 1981 due to budget cuts, a project was initiated to disseminate nutrition information by computer. It was a joint venture between the University’s Office of ComputerBased Instruction and the coordinated undergraduate program in dietetics. A group of student dietitians were organized to use a computer network. They developed an electronic bulletin board called "Nutrition Notes," which could be accessed by the university from more than 150 terminals distributed throughout the campus. Ques­ tions about nutrition were presented to the system and student dietitians responded with current and accurate information. The file remained operational for eight weeks during the fall semester. More than 50 questions were submitted to it. Inquiries were related to obesity and weight control, acne, diabetes, vitamins, and the effects of menstruation of eating. The bulk were single topic questions. Because of its success, the project was expected to be continued. Not only did this experience serve the university community but it enabled dietetic students to partake of a significant experience using computers to trans­ mit information. Encouraged by their success, the authors stated that more computer experiences were being planned and developed for nutrition education.

155.

De St. Jeor, Sachiko, Roger Millar, Frank H. Tyler. "The Digital Computer in Research Dietetics." JOUR­ NAL OF THE AMERICAN DIETETIC ASSOCIATION 58 (May 1970): 404-408. De St. Jeor et al. showed how digital computers were used by research dietitians in the Clinical

134

Computer-Based Education Research Center at the University of Utah Medical Center. These uses included (a) quantitative analy­ sis of nutrients in diets, (b) analysis of recipes, and (c) summaries of dietary intakes. Additionally, they described the development of a nutrient equiva­ lent program. It was designed to calculate the quan­ tity in gram portions of foods that would yield a specific amount of a given nutrient. With such in­ formation on hand, food lists could be generated for counseling patients on therapeutic diets who required restriction or supplementation of a specific nutrient or nutrients. For example, if a kidney patient needed a potassium-restricted diet, the computer-generated nutrient equivalent lists, arranged by food cate­ gories, would facilitate accurate quantitiative con­ trol for potassium. This would be accomplished by providing the patient with detailed lists of foods that would be useful in planning his diet within the prescribed limitations. De St. Jeor et al. claimed that the computer increased the productivity of re­ search dietitians in their unit. About 2,500 diets a year were calculated using the nutrient equivalency system. Finally, the lists were also used to develop recipes and cyclical seasonal menus.

156.

Dow, Ruth M. "Simulations Teach Management and Nutri­ tion Counseling Skills." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 79 (October 1981): 453-455. Dow of Eastern Illinois University used computer simulations to teach management and nutrition counsel­ ing skills. The author argued that such simulations were instructionally advantageous in a number of ways. For example, computer management problem simulations were realistic and self-instructional. Moreover, they promoted interaction and served as models for future professional practice in dietetics. In terms of educational technology, computer simulations could be easily updated and modified. Interactive computers were thought to be particularly useful in designing complex simulations. This feature was thought to en­ courage students to visualize themselves as profes­ sional dietitians. The addition of videotapes allowed learners to observe the subtler elements of the counseling and

Clinical Nutrition

135

human relations process. Dow suggested that the combination of the computer and videotaped simula­ tions could be achieved through the interactive optical videotape system, then a relatively new tech­ nology. The author outlined steps in developing management problem simulations. She stressed that they should be developed in consultation with a computer program­ mer to ascertain that they are compatible with com­ puter capabilities. Computer-based simulations have broad applications across all educational levels within the discipline. Dow pointed to uses with her diet therapy students. She further suggested that simulations could be used in two-year dietetic technician programs, coordinated undergraduate programs in dietetics, internships, graduate education, and inservice training for health care facility staffs. The author cited numerous examples to illustrate how simulations could be used. These included eval­ uation of skills, review or application of cognitive materials, selection of problem-solving strategies, and analysis of student thought processes. Dow described the integration of simulations into the existing curriculum. She stated that experience had demonstrated that simulations are most effective when they are linked to lectures and discussions and followed by debriefings. Also, the case was made that those students participating in complete, inte­ grated simulations had achieved higher scores at every level of cognitive skill. This was especially true with respect to higher-level mental processes such as analysis, synthesis, and evaluation. In sum, Dow concluded that computer-based simula­ tions had many advantages and some disadvantages in teaching management and counseling skills. For one, it avoided the inherent risks associated with actual situations, including potential emotional and/or phy­ sical danger to patients. Secondly, simulations can approximate real diseases or situations which might not be available for study when needed. On the other hand, simulations may not be sufficiently realistic

136

Computer-Based Education and may thus mislead students. The author concluded that there was promise and challenge in developing computer-based clinical and management simulations in dietetic education.

157.

Welch, Ann C., and Mary S. Breese. "Computer-Simulated Clinical Encounters: Case Flow and Program Content." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 70 (April 1977): 385-388. The authors describe the components of a computersimulated clinical encounter and student progression through a computer-mediated case study. The develop­ ers of the case studies used actual medical records to ensure realism, accuracy, and uniformity. Actual data was altered in order to meet the requirements of each case and to ensure the patients’ anonymity. Even though the organization and categorization of the cases differed from those found in the hospitalbased situation, both contained the same data. A number of resources were made available to stu­ dents during the two-day simulated clinical encounter On the first day, for example, the student received background information about the patient such as name address, birth date, diet orders, and service admit­ ted into the hospital, that is, medical or surgical. In addition to the patient’s background information, resources available for review included the medical record, nursing card index, hospital formulary, and nutrient catalogue. The student had to decide which resources he would use in the process of gathering additional informa­ tion and whether to interview the patient first. Students were encouraged to preview all the informa­ tion contained in each of the resources prior to the interview. However, they had the option of reviewing each one or only those categories within each re­ source that might contain relevant data. By completing the computer-simulated case study, the student was provided with a written comprehensive model containing all steps in the nutritional care of a patient. Furthermore, the completed study provided the faculty with a written record of the student’s

Clinical Nutrition

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responses to the patient’s inquiries and his organ­ ization of the clinical encounter and patient coun­ seling, as well as his knowledge of the subject mat­ ter. This written record enable students and faculty to analyze and strengthen students’ clinical skills.

MANAGEMENT

158.

Canter, Deborah D., and Betty L. Beach. "ComputerAssisted Instruction for Decision Making in Food Systems Management.” JOURNAL OF THE AMERICAN DIETET­ IC ASSOCIATION 78 (April 1981): 338-342. Since first-hand experience in managerial decision­ making is often limited or not available to dietetic students, Canter and Beach of the University of Ten­ nessee, Knoxville, developed a computer-based method to address this instructional problem. Their purpose was to assess the effectiveness of computer-assisted instruction in simulating personnel management deci­ sion-making experiences which were not usually avail­ able to senior dietetic students. The authors described a model for the inclusion of CAI in a dietetic education program. They illus­ trated it as a flow diagram. It began with a needs assessment and proceeded to a formulation of priori­ ties to ascertain whether needs were met by CAI. Then CAI was placed into the educational framework of the desired learning goals. This was followed by simultaneous development of clinical and didactic activities. CAI lessons were developed. Again these were tested to determine whether they met their in­ tended purpose. If not further development work was required. If intended goals were met, then CAI les­ sons were implemented. These were reevaluated to determine once again whether needs were actually met. If not, further refinement and development was under­ taken. CAI case studies simulations relating to person­ nel management were presented to 48 students. The authors stated that their most significant overall benefit was to increase student confidence in dealing

138

Computer-Based Education with personnel decision-making. However, the authors cautioned that case study simulations did not appear to provide sufficient "experience" to promote sig­ nificant changes in these managerial skills. Students and faculty expressed a positive attitude towards the CAI experience. The authors demonstrated that the use of CAI simulations in a coordinated undergraduate dietetic program was feasible. Finally, they recom­ mended that further research was needed on CAI in addressing both cognitive and affective competencies in dietetic education. This work was a milestone since Canter and Beach were one of the first research­ ers to propose a model for the systematic integration of CAI into a dietetic education program.

159.

Hoover, Loretta W . , and Aimee N. Moore. "DIETETIC COMPAK." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 64 (May 1974): 500-504. DIETETIC COM-PAK, an educational computer model developed by Hoover and Moore, of the University of Missouri-Columbia (UMC), was designed to provide learning experiences for dietetic students and dieti­ tians in computer applications in food systems man­ agement. The model consisted of four computer-assist­ ed subsystems. These included: Production Control, Inventory Control, Food Cost Accounting, and Patient Nutrient Intake Analysis. The model was in use in more than 40 higher education institutions in North America. By participating in data preparation for the system, dietetic students were able to gain a perspective on the significance of the four subsystems in an ongoing operation. Related entries appear in items 160, 161, 162, and 166.

160.

Hoover, Loretta W . , and Aimee N. Moore. DIETETIC COMPAK: INSTRUCTOR’S GUIDE. Columbia, Missouri: Uni­ versity of Missouri Technical Education Services. 1972. Hoover and Moore developed an educational model to teach concepts of computer-assisted food systems man­ agement to graduate and undergraduate dietetic stu­ dents and interns. The program, DIETETIC COM-PAK, was designed to simulate computer-assisted food

Management

139

systems management in a large medical center. The instructional package, according to the authors, was developed to allow for the transfer of technology from an institution involved in developmental re­ search in the area (UMC) to other institutions ininvolved in professional education. The package consisted of the simulation software, DIETETIC COMPAK, along with the instructor’s guide, a student guide (item 160), and technical guide (item 161). DIETETIC COM-PAK gave students the opportunity to get acquainted with computing techniques in food systems management. It also enabled them to inter­ pret computer-generated reports. Student assignments required inputting data on computer terminals, de­ tecting and correcting errors found in the printouts generated. These errors closely simulated those en­ countered in "real world" operation. Hoover and Moore claimed that the package provided a level of training and experience sufficient to inculcate and promote competence upon those who trained on it.

161.

Hoover, Loretta W . , and Aimee N. Moore. DIETETIC COMPAK: STUDENT GUIDE. Columbia, Missouri: Lucas Brothers Publishers. 1972. The DIETETIC COM-PAK (items 159, 160) student guide includes learning activities that facilitate instruction and "hands-on" experiences in computerassisted management to undergraduate and graduate dietetic students and interns. The guide consists of five major sections covering the following topics 1.

Computer-assisted food systems management

2.

Inventory control subsystem

3.

Production control subsystem

4.

Food cost accounting subsystem

5.

Patient nutrient intake subsystem

140 162.

Computer-Based Education Hoover, Loretta W . , and Aimee N. Moore. DIETETIC COMPAK: TECHNICAL GUIDE. Columbia, Missouri: University of Missouri Technical Education Services. 1972. The purpose of the Technical Guide is to facili­ tate installation of DIETETIC COM-PAK (items 159, 160). The guide was developed by computer program­ mers and systems personnel at the University of Missouri-Columbia (UMC) Medical Computer Center. The guide contains information on the characteristics of the data files, hardware requirements, and the in­ terrelationships among the data files included in the manual. Also, Job Control Language (JCL) statements required for the system (as used at UMC) are included in order to guide users of the system in copying data files and computer programs from the magnetic tape on which they are delivered for execution upon installat ion.

163.

Njus, Helen P., Shirley C. Gilmore, Alyce M. Fanslow, et al. "Some Problem-Solving Techniques Applied to Nutrition Education Software." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 53-57. Njus et al. described six problem-solving techniques which, based on their experience in designing and debugging educational software, they had found help­ ful in converting nutrition education materials into user-friendly microcomputer software. The problem­ solving techniques involved (a) controlling the pace of the program, (b) simplifying directions given to students, (c) assuring that students would receive user-friendly feedback, (d) reducing the likelihood that the user could tamper with the program, (e) pro­ viding efficient record-keeping, and (f) preventing abnormal program termination. The authors illustrated the techniques with re­ ports of their experiences in designing the nutrition software program entitled WHAT I USUALLY EAT (Nation­ al Dairy Council, 1983). The authors believed that the six identified techniques were applicable to all types of educational software. Furthermore, they asserted that their application would provide students with a positive, secure, and efficient computer-based learning experience.

Management

141

These researchers, who were nutritionists and educators, worked with programmers to convert the portotype to the computerized program. With the emergence of increasingly sophisticated authoring systems, the number of people involved in software development for instructional purposes could be dramatically reduced. Only two years after the pub­ lication of Njus and associates’ article, a multi­ tude of such systems was commercially available. Many of these incorporated the six problem-solving techniques described by the authors. Since the technology is rapidly changing, it is important for those considering the design, development, imple­ mentation, and evaluation of computer-based nutrition education to keep up with advances in this area.

FOOD SERVICE OPERATIONS

164.

Eisele, Jill E. "Computerized Foodservice Management— Bibliography for Classroom Use." JOURNAL OF DIETETIC SOFTWARE 2 (Winter 1985): 5-6. With the aid of an Apple 11+ microcomputer and a data base management application software package, the author developed a food service management bib­ liography. File organization was based on the Amer­ ican Dietetic Association's Management Bibliography for Dietetic Practitioners. A file was created on a floppy disk consisting of 5 categories and subsec­ tions. These were: Section 1.

Procurement and Production Information

Section 2.

Management Control Theory

Section 3.

Personnel Management Administration

Section 4.

Management Control Techniques

Section 5.

Layout and Design

Educational applications of the system are de­ scribed.

142 165.

Computer-Based Education Sawyer, Carol A., Antoinette L. Colucci, Nancy Graves, John B. Knight, Joan Koch, and Tom Pearson. "Guide­ lines for Use of Comprehensive Foodservice Software Systems in Academic Settings." JOURNAL OF DIETETIC SOFTWARE 2 (Summer 1985): 3-4. The academic potential of using comprehensive food service software systems in university curricula is explored. Academic potential refers to classroom instructional applications at the university level. Whereas comprehensive food service software refers to software packages with programs that execute a wide range of food service operations including pur­ chasing, production, precosting, inventory manage­ ment, labor scheduling and nutritional assessment. This paper considers developing behavioral objec­ tives for a computer-based course in food service systems management, the teaching environment, in­ structional techniques, evaluation of student per­ formance, and comments on the future.

166.

Sifferman, Christine K., and Loretta W. Hoover. "InBasket Exercise to Teach Computer-Assisted Food Systems Management." JOURNAL OF THE AMERICAN DIETET­ IC ASSOCIATION 78 (February 1981): 165-168. The dietitian’s management role in computerassisted systems involves more than mere preparation of operational data. It also entails responsibility for problem solving, data interpretation and analy­ sis, establishing priorities, staffing, and dealing with problems unique to the technology itself. To gain management competence it is widely believed that experience is the best teacher. Nonetheless, it is not always feasible to train students properly in this area. Based on this reasoning, Sifferman and Hoover decided that an instructional simulation would be the next best approach. Since the in-basket exercise is considered a good means to stimulate reality in an educational environment, they decided to use it to teach computer-assisted food systems management. Simply stated, an in-basket exercise involves a hypothetical work situation wherein a participant is

Food Service Operations

143

required to take action on a series of documents de­ posited as incoming mail into an in-basket. Such may include memos, letters or other communications eliciting action. A major strength of the in-basket exercise is that it allows the participant to make decisions in a safe environment and the opportunity to discuss each decision with instructors and peers. Sifferman and Hoover developed and evaluated an in-basket exercise to be used in conjunction with DIETETIC COM-PAK. It was designed to provide stu­ dents with an insight into the managerial role of administrative dietitians who use computer assistance. The instructional tool was appraised by dietitians, dietetic educators, and students. Evaluators en­ dorsed the in-basket exercise as an educational tool on the basis of its suitability for educational use and its conformance to predetermined criteria. The authors cautioned that since the simulation was de­ veloped for use with DIETETIC COM-PAK it should only be used by those familiar with it. They concluded that other in-basket simulations should be developed covering different situations since the technique was well accepted by students.

FOOD SCIENCE

167.

Adams, J. Peter. "Statistical Analysis in a Food Science and Engineering Laboratory Course." FOOD TECHNOLOGY 39 (April 1985): 103-106, 118. Efforts to integrate the use of computers and basic statistical techniques into a statistics course recommended by the Institute of Food Technologists are described. The experience over the past 4 years is depicted as frustrating at times, but beneficial for students and instructors. Development of labora­ tory experiments suitable for statistical analysis is a time-consuming task which will take time and ex­ perience to master. Notwithstanding, graduate stu­ dents were described as specific beneficiaries of the system because exposure to computer-based statistical packages could later assist them in producing a thesis.

144 168.

Computer-Based Education Heldman, Dennis R., and James F. Steefe. "Educational Uses of Computer Models for Food Freezing Processes." FOOD TECHNOLOGY 39 (April 1985): 87-91. The food freezing process has many unique and important features applicable to food science and engineering students. The objectives of this paper are to: (a) describe the components of a computersimulated program of the food freezing process; (b) illustrate how the computer can aid in the study of the food freezing process; and (c) discuss ways for improving computer-assisted education on the subject of food freezing.

169.

Holmes, Zoe A., Dean Osterman, and Robert McNaughton. "Computer-Simulated Laboratory Experiments in Food Science: Part I: The Model." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 76 (May 1980): 471-474. The authors developed a computerized model de­ signed to increase students' problem-solving skills using simulated laboratory experiments in food sci­ ence. The model was developed with two criteria in mind: (a) It would facilitate learner's problem­ solving activities, and (b) it would be sufficiently flexible to allow development of problem-solving skills in food science by both students and profes­ sionals alike. The computerized model consisted of 25 separate simulations. Each covered a distinct topic area of food science. Topics included sugar crystallization, shortenings and other fats, starch, flour mixtues, eggs and dairy products, meat-beef, and fruits. In addition to the breadth of coverage, the model also featured experiments of differing levels of complex­ ity. The computerized simulations were based on topics derived from an analysis of the relevant literature. Both a "Student Guide" and an "Instructor's Guide" were developed to support the simulations. These three components comprised a package that enabled students to receive an activity or a problem state­ ment, conduct an experiment on the computer, and analyze the data on the printout. The authors pre­

Food Science

145

sented a flow diagram illustrating the logical steps involved before the initiation of the simulation. Problems or activities assigned to the student were related to the stated goals and objectives of the particular course or seminar in which they were en­ rolled . In sum, the authors claimed that the logical steps leading to a reasoned conclusion, via computerized simulations, enabled students to acquire fundamental knowledge in food science while simultaneously de­ veloping their problem-solving skills. The model was evaluated and the findings were reported in a sequel article (item 170).

170.

Holmes, Zoe A., Dean Osterman, Marta Marshall, and Joan Barrett. "Computer-Simulated Experiments in Food Science: Part II. Evaluation of the Model in Use." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 76 (May 1980): 474-476. Holmes et al. reported on the effect of computer­ ized simulations on instruction, on students’ attitued towards the medium, and on the extent of knowl­ edge acquired. The researchers collected evidence to indicate that computer simulations were success­ ful in teaching food science. They concluded that the simulations could be used to replace laboratory experiences. Students' attitudes concerning the value of the course were found to be more positive when computer­ ized simulations were used. The findings were de­ rived from nine of eleven attitudinal test items to which the students responded following exposure to the simulations. The researchers concluded that students not only did better, but also liked the computer-based instruction. The results of this evaluation reinforced the case for using computer-based simulations of labora­ tory experiments in food science (item 169). Specif­ ically, the students found the simulations highly motivating while they sharpened problem-solving skills and promoted academic achievement.

146____ Computer-Based Education 171.

McLellan, Mark R. "An Introduction to Computer-Based Process Control in a Food Engineering Course." FOOD TECHNOLOGY 39 (April 1985): 96-97. A description of how microcomputer technology was integrated into a food engineering course at Cornell University is described. Student response was ap­ praised. The overall response was favorable despite the newness and volume of the material covered. A related computer-based laboratory experience is de­ scribed in item 172.

172.

Mulvaney, S.J., G.E. Houghton, and S.S.H. Rizvi. "De­ velopment of Computer-Based Process Control Experi­ ments for a Food Engineering Course." FOOD TECHNOLOGY 39 (April 1985): 98-102. Two laboratory exercises developed at Cornell University to teach food science majors about com­ puters, how they operate, and what they can accomplish as part of a process control system, are described. The 5 objectives of the laboratory course were to en­ able each student to: 1.

understand the number systems used by com­ puters .

2.

become familiar with a microcomputer’s hard­ ware organization.

3.

write and execute simple programs using highlevel computer language.

4.

experiment with digital and analog input/ output devices.

5.

interface a computer to control elements and signal transducers.

Both hardware and software considerations relevant to the design of the labs are discussed. In the opin­ ion of the authors, the computer-based laboratory ex­ ercises and correlated lectures yield a suitable com­ promise between excessive detail and a mere survey of process control theory.

Food Science 173.

14 7

Okos, M.R., and G.V. Reklaitis. "Computer-Aided Design and Operation of Food Processes in Industry and Aca­ demia." FOOD TECHNOLOGY 39 (April 1985): 107-118. An overview of promising computer aids for food process design for use by academia and industry are described. Although numerous computer programs exist that can be applied to different food products, dis­ cussion is limited to the aids used at Purdue Univer­ sity for the design and operation of food processes. Therefore, this paper focuses on dairy process. Ex­ amples include preliminary design, process synthesis, material and energy balancing, and process simulation. Computer aids for process engineering have not been widely used because of the incompatibility of data structures, the complexity of individual programs, and rigid input requirements. The concept of the integrated computer-based proc­ ess control workstation is presented. The authors argue for the benefits of these workstations in in­ dustry and academia.

174.

Shoemaker, Charles F., and Gerald F. Russell. "A Course in Computer Technology for Food Science Stu­ dents." FOOD TECHNOLOGY 39 (April 1985): 92-95. The contents and rationale of a course entitled "Microcomputers in the Lab," designed to teach ap­ plications of computer technology to students in the Department of Food Science and Technology at the Uni­ versity of California at Davis, are presented. Topics included in the course, which deals primarily with computer interfacing for laboratory and process con­ trol, are listed and described. Among the topics addressed by the course are digital logic, numbering systems, microcomputer architecture, parallel and serial interface, synchronization of data transfer, subroutines, data transfer and acquisition by com­ puter, software packages for data analysis, and lab­ oratory computer systems and local networks.

175.

Steffe, James F. "Computers in Undergraduate Food Science Education— A Survey.” FOOD TECHNOLOGY 36 (October 1981): 98-103.

148

Computer-Based Education Steffe surveyed all undergraduate food science ed­ ucation programs in the United States and Canada to assess the extent of computer use in the discipline. Specifically, he set out to determine the following: (a) the number of food science departments that man­ dated students to enroll in computer-related courses, (b) which departments required students to become proficient in a programming language, (c) the extent to which students were exposed to computer-based in­ formation retrieval systems, (d) the types of courses that food science majors took not offered by the food science department, and (e) the extent of computer use in undergraduate instruction in food science. Based on the survey responses, Steffe concluded that computers in undergraduate food science education were under-utilized. Furthermore, he suggested that expanded use of existing software would significantly improve many educational programs. He went on to recommend that the Institute of Food Technology’s Undergraduate Minimum Standards require courses in information processing and computer. He reasoned that such measures would go a long way toward improving degree programs and advancing the food industry.

GENERAL PUBLIC

176.

Slavin, Joanne L., Mary E. Darling, and Melody L. Mattson. "Computer Experiences in Food and Nutrition Cooperative Extension Programs." JOURNAL OF NUTRI­ TION EDUCATION 16 (June 1984): 70-72. Efforts by the Minnesota Cooperative Extension Service to develop computer programs and apply the technology to improve and expand its educational ef­ forts in foods and nutrition are described. Four mainframe computer programs are listed and discussed including: (a) FOOD INTAKE AND ANALYSIS (FOINANA), (b) LEARNING ABOUT EATING, ACTIVITY, AND NUTRITION (LEAN), (c) F00D$, and (d) RECALL. Microcomputer-assisted instruction to date, in the area of cooperative extension in Minnesota, has been for "attention-getting" purposes. Software is

General Public

149

obtained from the Minnesota Education Computing Con­ sortium (MECC) which provides educational software to Minnesota schools. The limited number of micro­ computers available, coupled with consumer preference for short, uncomplicated programs, especially in crowded malls and supermarkets, increase the demand for simple programs. This creates the need for a nutritionist or home economist to be present to in­ terpret information and to answer consumers ques­ tions. Microcomputer software used by Minnesota cooperative extension workers include: (a) CEREAL, (b) FAST FOOD, (c) FOOD COSTS, and (d) SODIUM AND YOU. An innovative application of the technology is described wherein a directory of food preservation questions and answers is computerized. These can be accessed using key words. For example, by typing "strawberry" and "freeze," a list of questions and answers on the subject will appear on the computer. This saves county extension workers considerable time during the food preservation season. Future plans call for the development of an IBM Personal Computer-compatible program entitled HEALTHY EATING. Also, a computer-to-computer data communica­ tion system is envisioned. The FOODS AND NUTRITION BULLETIN BOARD SYSTEM (BBS) will eventually contain current food and nutrition topics that could eventu­ ally be accessed by other microcomputers located throughout the state.

177.

Slavin, Joanne L., and Melody Mattson. "Microcomputers Energize and Exercise Programs." JOURNAL OF DIETETIC SOFTWARE 1 (Fall 1984): 5-7. Researchers at the University of Minnesota have used microcomputers to enhance nutrition education for the general public. Such efforts are described along with some potential problems encountered when using microcomputers to teach nutrition. Although the software used to teach may be effective, hind­ rances are connected with hardware constraints, labor costs, support personnel, and logistics.

130 178.

Computer-Based Education Smicklas-Wright, Helen, Suzanne Pelican, Carol ByrdBredbenner, and Barbara Shannon. "Client’s Compre­ hension of a Computer-Analyzed Dietary Intake Print­ out." A study was conducted to determine how well older adults were able to understand a computer-generated printout of a 24-hour food record and accompanying explanatory pamphlet. A questionnaire was completed by 84 individuals who responded to a pension check envelope enclosure offering a free 24-hour food record. Diet records were evaluated using the EATS computer program. Individuals who reported less than 68% of the RDA for any nutrient received a message indicating that their intake was less than two-thirds of the RDA. Alternatively, those exceeding the allowances for protein, sodium, and vitamin A also received caution­ ary messages. Printouts of diet analyses along with an explana­ tory pamphlet and questionnaire were sent to the individuals surveyed. The questionnaire was de­ signed to determine each respondent's understanding of the RDAs. It was apparent that respondents ex­ perienced a number of difficulties which were out­ lined in the article. Of particular importance was the finding that respondents held various miscon­ ceptions concerning the RDA concept. The authors concluded that printout recipients should receive clearly written and legible supplementary informa­ tion to prevent misconceptions that arise from in­ terpreting the RDAs. The authors proposed the need for nutrition educators to identify and apply tech­ niques that make computer-generated information readable and understandable. Items 88, 94, and 105 relate to the subject of this article.

179.

Wheeler, Gloria. "Computerized Feedback and Recipes for Family Day-care Providers." JOURNAL OF NUTRI­ TION EDUCATION 16 (June 1984): 76F. A computerized letter system was developed to furnish timely feedback and nutrition information to providers enrolled in a USDA Child Care Food

General Public

151

Program. The letters focused on the Child Care Food Program’s need to comply with USDA requirements. Nutrition information was given to providers, and they, in turn, were supposed to deliver better nu­ trition for the children in their care. At first, response to the letters was not positive. It was thought that the quality of the dot-matrix printed letters was part of the reason for the poor response. Also, providers felt that the letters were too im­ personal. The situation was improved when a letterquality printer was acquired and letters were per­ sonal ized.

180.

Wheeler, Lawrence A., Madelyn L. Wheeler, Patricia Ours, and Cynthia Swider. "Evaluation of ComputerBased Education in Persons with Diabetes Mellitus and Limited Educational Background." DIABETES CARE 8 (November-December 1985): 537-544. A study was conducted to determine if computerbased meal planning and diet education can effective­ ly supplement diabetes diet counseling among innercity subjects with limited educational background. Sixteen diabetics who were newly referred to an inner-city outpatient diet counseling clinic and who read at the ninth-grade level were given computerbased nutrition education. Patients were provided with nutrition information via an integrated computerassisted, interactive videodisc system. By the end of the fourth week group performance was improved when measured in terms of (a) knowledge of the Ex­ change Lists, (b) recognition of foods containing concentrated carbohydrates, (c) weight loss, and (d) reduction of fat intake. On the other hand, no im­ provement was noted in food-measuring skills or in calorie-consumption compliance. It was concluded that computer-based approaches appear to be accept­ able adjuncts to traditional instructional methods in this patient group. Also, computers can enhance the effectiveness of diabetes education programs without increasing commitment of the dietitian's time.

152

Computer-Based Education HIGHER EDUCATION

181.

Dubin, Stephen, Chia-Lin Chu, John Weiher, and Chiong Lin. MA Computer-Graphic Method of Teaching Protein Chemical Score Concepts." JOURNAL OF NUTRITION EDU­ CATION 14 (March 1982): 18-20. A computer program that automatically performed the tedious calculations involved in determining pro­ tein chemical score, an index of the degree of balance of dietary amino acids in a protein is described. The program also presented a graphic display illus­ trating the concept of protein complementarity and the relationships among dietary essential amino acid patterns, protein concentrations, energy considera­ tions, and deamination burden. Such features were very useful as teaching tools. Although the program could not be used to calculate optimal mixtures, the authors stated that the best application of their program was to carry out the burdensome calculations and display the complex interrelationships among the different parameters. The merging of the computing and graphics capa­ bilities of the computer created a useful instruc­ tional tool to facilitate student visualization of a complex concept. Thus, the foundation was laid for the development of future instructional computing programs in nutrition with enhanced graphics capa­ bilities. Considering the expected rise in the availability of personal computers, it would be worthwhile to design and develop simple diet plan­ ning programs, integrating such capabilities, for use by lay persons. Professionally developed pro­ grams of this type would go a long way to improve the diet of motivated individuals.

182.

Duford, Sally T., Judith S. Payne, and Kathryn H. Timmons. "Computer Use in a Nutrition Course for Elementary Education Majors." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 76B. Incorporation of computer experiences into a nu­ trition education course for elementary education majors is described. The course is designed to teach

Higher Education

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how principles and methods of nutrition education may be integrated throughout the elementary curricula at various grade levels. Highlighted in this report is a brief description of how education majors learn how to apply microcomputer technology to teach nutrition to elementary school children.

183.

Hoover, Loretta W., and Suzanne Pelican. "Nutrient Data Bases— Considerations for Educators." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 58-62. The authors were one of the first researchers to examine the sources and limitations of nutrient data bases applicable to nutrition educators. They dis­ cussed several educational issues surrounding the selection and use of nutritional analysis software. The authors argued that educators should be aware of the various sources of limitations inherent in all nutrient data bases. In an attempt to enlighten nutrition educators about the limitations of nutrient data bases, Hoover and Pelican described four potential sources of var­ iability and error. The first was the limitation associated with the status of nutrient assay tech­ niques. Food scientists are still developing and refining procedures to determine the exact nutrient composition of foods. Consequently, some nutrient data may be adequate whereas others may be conflict­ ing or nonexistent. As in Hepburn1s report (item 97), the authors presented an updated table describ­ ing the status of existing methodologies for assaying the nutrient composition of foods. A second limitation of nutrient data bases was linked to the variable nutrient content of foods. Such variability is associated with differences in the regions where foods are grown, their degree of ripeness, and length of storage and handling. Simi­ larly, food preparation techniques may change the nutrient content of foods. This was identified as a third limitation of nutrient data bases because they often fail to account for nutrient changes in cooking Educationally, nutrient accounting is important be­ cause a nutritional analysis of a recipe should ac­ curately reflect nutrient losses during preparation.

154

Computer-Based Education Therefore, the authors warned that nutrition educa­ tors should scrutinize analytic software for its ability to accurately compute nutritional values from recipes. A fourth limitation dealt with the ever-changing nature of the American food supply. For example, nu­ trient data change when new food enrichment standards become effective. Additionally, the continuous in­ troduction of novel food products into the market­ place, coupled with new food processing techniques, alters the nature of nutrient composition data. Con­ sequently, nutrition educators were warned that fail­ ure to update nutrient analysis programs on a periodic basis would result in obsolete data bases. Hoover and Pelican recognized that educators face multiple constraints when considering the selection of a nutrient data base. Such factors as target au­ dience, instructional goals and objectives, and limi­ tations of institutional resources warrant tradeoffs. On such a basis, the authors recommended that nutri­ tion educators involved in the selection of a nutrient data base should reflect upon its completeness, com­ prehensiveness, currentness, and sources of data. Moreover, appropriate hardware becomes an important issue. All of the above should be carefully weighed to ensure that a proper decision is made. Finally, the authors concluded their report with a series of evaluation questions focusing on the needs of nutrition educators. They dealt with four areas that facilitate an initial examination and evaluation of a nutrient data base including: (a) the data base core, (b) supplementary data, (c) the completeness of the data base, and (d) data base management.

184.

Lambee, Maureen. "Software Program Teaches Concept of Nutrient Density." FOOD & NUTRITION NEWS 58 (November/December 1986): 32. POWER PACKED scribed in this and sixth grade density. Prior

NUTRITION is a software package de­ report. It is designed to teach fifth students about the concept of nutrient to developing the software, a study

Higher Education

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was made of the school market place and existing software. Their findings revealed a prevalent lack of good instructional software. Furthermore, their study found that teachers have become more sophis­ ticated and will only accept instructional software that makes use of the unique capabilities of micro­ computers to teach a topic that fits a specific cur­ riculum area. The survey of existing software for all grades and curriculum areas established that the majority of nutrition programs on the market involved dietary recall and analysis. These programs are appealing to teachers because (a) students develop heightened awareness of nutrition as they evaluate their diets, and (b) such programs make use of the microcomputer’s unique ability to store large amounts of data.

185.

Law, Patricia B.M. "Educational Application of Com­ puters: A Descriptive Study of Home Economics Educa­ tors in American Colleges and Universities.” Ed.D. diss. Brigham Young University. 1983. The purpose of this dissertation was to discover the following information about personal and profes­ sional use of computers by home economics educators: 1

.

available computers at work or home,

2.

computer applications,

3.

software source and satisfaction,

4.

physical location of computers,

5.

computer assignments required of students,

6.

person at home making the most use of com­ puters and the factors influencing that use

The findings are reviewed and conclusions drawn thereof. Six recommendations are made based on the conclusions.

156 186.

Computer-Based Education Maruyama, Fudeko F., J. Darlene Forester. "Programs with Color, Sound and Graphics." JOURNAL OF NUTRI­ TION EDUCATION 16 (June 1984): 57. Maruyama and Forester successfully developed a series of computer-based instructional programs on a variety of nutrition topics, including selection of good snacks, nutrition for the athlete, vitamin facts and falacies, food sources of nutrients, sugar in the diet, and diet and health. Their tar­ get audience consisted of consumers and passers-by in places such as shopping centers and fairs. They used university computer science students to write the programs based on the content they had specified. Their contribution was unique in nutrition edu­ cation, since up to that time there had been no pub­ lished reports of programs utilizing sound (music), and animated graphics. County home economists who evaluated the use of these programs indicated that they were effective. They reported that people found computers enjoyable and appreciated quizzes and games incorporating color, sound, and graphics. It was further noted that it was desirable for the pace of these instructional programs to be selfregulated because of differences in people’s reading rate. Also, observers found that when access by large groups is crucial, programs should not last longer than three or four minutes to be useful.

187.

Molleson, Ann. " ’Dietan’— A Computer-Assisted Pro­ gram on Anatomy and Nutrition." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 68 (January 1976): 46-47. A computer-assisted instructional program on anatomy and nutrition called "Dietan" was designed to correlate anatomy with nutrition for medical dietetics students at The Ohio State University, Columbus. The course was designed to allow students to re­ view applications of anatomy relevant to the dieti­ tian. Planning the program involved dietetics fac­ ulty, staff dietitians of The Ohio State University Hospitals, and the Department of Anatomy. These

Higher Education

157

people were consulted for suggestions on what a practicing dietitian needed to know about human anatomy. For expert advice on the logistics of developing the CAI programs, personnel from The Ohio State Regional Medical Program Computer-As­ sisted Instruction Study were consulted. The course supplemented lecture materials. It consisted of nine modules. Topics covered included the musculoskeletal, digestive, cardiovascular, en­ docrine, and nervous systems; the liver; and the kidney. Each module addressed certain anatomical con­ cepts related to human nutrition. The purpose of each module was to review structural and functional concepts related to nutrition. The program con­ tained a glossary of approximately five hundred words. Therefore, students were able to ask the computer to define unfamiliar terms. In order to vary instructional techniques, vari­ ous types of testing formats were used to question students. These included multiple choice, true or false, ranking, matching, and constructed responses. Branching capabilities were built in to handle com­ plex questions. This allowed students to be tutored when they answered questions incorrectly. Upon the completion of each session the student obtained a printout of the module completed, useful for pre­ paring for future examinations. Students participating in the CAI program indi­ cated that they were challenged to learn more about anatomy while simultaneously gaining a greater un­ derstanding of its relationship to human nutrition.

188.

Murphy, Suzanne P., Janet C. King, and Doris H. Calloway. "Choosing a Diet Analysis System for Classroom Use." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 73-75. The authors described their experiences and pre­ sented recommendations for using computerized die­ tary analysis systems for educational purposes. Their perspective was drawn from their work at the

158

Computer-Based Education Department of Nutritional Sciences, University of California at Berkeley. There, students were intro­ duced to computerized dietary analysis procedures early in their introductory courses in human nutri­ tion. These researchers reasoned that choosing a computerized diet analysis system for classroom usage involved both software and hardware decisions. In terms of software selection factors, a number of items were outlined. First, a list should be compiled in order to itemize the desired capabili­ ties of the prospective system. It should include the type and number of foods and nutrients the data base should contain in order for students to design diets and derive reasonable diet analyses. Secondly, attention should be paid to the data input strategies required of different analytic software. Some re­ quiring elaborate coding schemes, for example, may not be efficient. A third consideration was whether a system could store recipes. This particular fea­ ture was considered educationally valuable because there is often a need for analyzing common mixed dishes or recipes. A fourth factor was a considera­ tion of how totals would be calculated and displayed. A fifth concern revolved around the issue of storing the results of diet analyses. Data base maintenance and management was a sixth factor thought to be worth considering, especially in view of ever-expand­ ing nutrient composition data. Finally, a seventh software consideration dealt with the systems docu­ mentation. The researchers recommended that docu­ mentation manuals should contain easy-to-understand sections for students, as well as more detailed sec­ tions for instructors. Once software decisions are made, the authors explained, hardware decisions are somewhat simpli­ fied. This holds true today. Nevertheless, hard­ ware considerations described in this report were dated when the report was published due to advances that led to the widespread availability of micro­ computer technology. Notwithstanding, since the authors projected their views to the future, four of their recommendations remain relevant today. First, the number of microcomputer workstations needed should be identified. Second, the question of stu­ dent access to these workstations should be addressed.

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Third, the number and location of printers from which to obtain printouts of diets analyzed should be specified. Lastly, availability of computing equipment in students’ homes may be a factor when considering hardware selection for classroom use. Murphy et al. were among the first researchers to enumerate many of the factors involved in choosing a diet analysis system for classroom use.

189.

Orta, John. "Computer Methods in Nutritional Analysis Report of a Prototype Undergraduate Course for Die­ tetic Students." JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 10 (October 1987): 1385-1386. Computer applications in dietetics have prolif­ erated over the past three decades. Many educators think that in order to strengthen dietetic education programs more emphasis should be placed on computers Experience has shown that several influences are currently pressuring dietitians to master the use of microcomputers as a professional tool. Increased regulatory demands, emergence of increasingly so­ phisticated dietetic software, and technological ad­ vances are some examples. Published reports are few that demonstrate how dietetic students are trained on how to select and use microcomputer nu­ tritional analysis software. The design, develop­ ment, and implementation of a prototype undergradu­ ate course on computer nutritional analysis tech­ niques is described along with the factors which made it successful.

190.

Orta, Juan E. "A Model for the Comprehensive Use of Computers in Nutrition Education." Ed.D. diss. Teachers College, Columbia University. 1987. In the not-too-distant future, computers will play a significant role in the generation, dissem­ ination, and consumption of knowledge in human nu­ trition in order to facilitate individualized at­ tainment and maintenance of health throughout all stages of the life cycle. Over the past quartercentury numerous computer applications have emerged in the foods and nutrition professions. Similarly, their sophistication and complexity have grown.

160

Computer-Based Education Today, computers are increasingly found and accepted in the nutritionist's workplace. However, few are professionally educated in their use, possibilities, and limitations. Colleges and universities have been slow in ad­ dressing this problem because of an absence of sys­ tematic guidelines to integrate computer applications across the curriculum. There is a growing gap be­ tween theory and practice, relative to the applica­ tion of computer technology to nutrition education problems. Following a detailed history of the emergence of computer applications in the discipline, an in-depth analysis of major considerations for establishing a computer-based curriculum is presented. Such con­ siderations include administrative factors, hardware and software issues, professional development, sup­ port personnel, and financial considerations for establishing a computer-based curriculum. Twenty arguments to justify establishment of a computerbased curriculum are proposed. A synthesis of known computer applications in the discipline, along with the analysis of considerations for establishing a computer-based curriculum, led to the development of a model for the comprehensive use of computers in nutrition education. The model dem­ onstrates how computers can play an important role in the process of nutrition education. This is il­ lustrated by a design which incorporates computers comprehensively into the flow of nutrition education, which proceeds from the knowledge generators, to knowledge disseminators, to consumers of nutrition education. It is argued that adaptive computer-based nutrition education will not only revitalize the profession but greatly enhance public health. Delib­ erations for future development of the model are pre­ sented .

191.

Pitts, Vikki. "Micro-Computer Assisted Development of Nutrition Education Materials." JOURNAL OF DIETETIC SOFTWARE 2 (Winter 1985): 2-4. The author argues that computers may be used not

Higher Education

161

only to teach, but also to increase the dietitian's capability to deliver meaningful nutrition educa­ tion without the technology claiming a visible role. Three microcomputer applications useful in the process of nutrition education are described, in­ cluding: (a) word processing, (b) computer graphics packages, and (c) computer-generated slide material.

192.

Schroeder, Lois A., and Daniel L. Driscoll. "Com­ puterized Learning for Clinical and Nonclinical Students." JOURNAL OF THE AMERICAN DIETETIC AS­ SOCIATION 83 (August 1983): 163-166. The nutrition faculty of Syracuse University in New York has experimented with computer-based edu­ cational technologies for a number of years. In one experiment they used computer-based instruction and the computer’s information management capabili­ ties to teach the renal component of a diet therapy course for dietetic students. A related paper is summarized in item 192. In order to determine the effectiveness of the system, a study was conducted to compare computer­ ized instruction with the traditional lecture method of teaching diet therapy. The performance of both clinical and nonclinical dietetics students was com­ pared. Although both groups were presented with the same subject matter, the clinical students had greater practical exposure to the nutritional man­ agement of end-stage renal disease than the non­ clinical students. The researchers had the following objectives: (a) to develop a computer-based, student-controlled, instructional system to teach renal diet therapy; (b) to incorporate versatile features into the sys­ tem in order to accommodate similar instructional units for other areas of diet therapy; and (c) to determine if computer-based education could become a primary mode of instruction equal to or better than traditional teaching methods. Statistical studies of pretest and post-test scores showed that both clinical or nonclinical students taught by computer achieved as well as

162

Computer-Based Education those taught by traditional methods. These findings demonstrated that computer-based instruction can be a primary means of teaching renal diet therapy to dietetic students. Moreover, extension of computerbased instructional strategies to other areas of diet therapy was thought feasible. In fact, the researchers concluded that computer-based education could provide students with a non-threatening means of practicing and perfecting new skills in dietetics while saving instructors’ valuable time.

193.

Schroeder, Lois, and Victoria F. Thiele. "Renal Diet Therapy— A Computer-Assisted Instruction Model.” JOURNAL OF NUTRITION EDUCATION 13 (1981): S111-S114. Among the more difficult areas to teach for the college nutrition professor is renal diet therapy. This area of instruction is time-consuming when taught by conventional methods. Schroeder and Thiele of the Department of Human Nutrition at Syracuse Uni­ versity reasoned that computer-assisted instruction was a promising alternative to conventional teaching strategies. In addition to facilitating individual­ ized instruction, CAI offered students the opportun­ ity to learn and manipulate the large amounts of factual data required to learn the subject. More­ over, with self-evaluation programs, student weak­ nesses could be diagnosed and remedial work pre­ scribed . Considering these factors, the authors concluded that a need existed for a self-instructional package to assist dietetics students in mastering the prin­ ciples of diet therapy in end-stage renal failure. Consequently, they designed a complete computerbased instructional system and investigated whether it could be used to teach renal diet therapy at a level of achievement of 80 to 85 percent of the max­ imum attainable score. Additionally, the investi­ gators wanted to assess student differences in atti­ tude and performance in renal nutrition between tra­ ditional instructional strategies and CAI. Three steps were involved in the development of the CAI model. The first was the design of an

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163

interactive component with questions and answers that matched each unit of the course’s study guide. Mixed strategies were employed. These included tutorial, and drill and practice. The second step was to de­ sign an interactive simulation placing students in the position of a hospital renal dietitian. Students were required to make decisions and calculate renal diets. The third step involved a system of computermanaged instruction (CMI). It included questions and answers related to the different learning units with appropriate feedback. Also, for purposes of simulating menus, it included menu items and their nutrient data. The CMI system also maintained records on all students who worked at the terminal. Several arguments were outlined favoring the use of computers in learning renal nutrition. For one, it takes considerable time to master renal diet cal­ culations. Therefore, a student beginning to learn renal diet therapy must manipulate many variables, especially those related to the nutrient and electro­ lyte content of foods, in order to calculate a diet prescription accurately. Since the computer handled burdensome calculations and students could practice until they arrived at the correct diet prescription, many commented that it was both enjoyable and effi­ cient to use the computer to calculate diets. The opportunity for unlimited drill and practice on the computer enabled students to develop skills and gain confidence in their work. In addition to facilita­ ting learning, the computer-generated evaluations saved instructors time and provided students with im­ mediate feedback. Finally, two additional strong points outlined were the degree of student control over their learning experiences and the individualiza­ tion of instruction that CAI made possible. In sum, the researchers concluded, based on the evaluative data derived from the CAI model, that CAI was successful in teaching nutrition students renal diet therapy at an acceptable level of achievement. In fact, those learning renal diet therapy by means of the CAI model exhibited equal mastery of the sub­ ject matter relative to those who learned it by con­ ventional methods. Moreover, the students’ attitude towards learning with computers was positive. Thus, the research indicated that CAI may be a useful and

164

Computer-Based Education justifiable substitute for the traditional classroom presentation of renal diet therapy. An earlier re­ lated study is found in item 192.

194.

Schvaneveldt, Noren B., and Gail Duering. "Computer Applications in a Coordinated Undergraduate Program." JOURNAL OF DIETETIC SOFTWARE 1 (Fall 1984): 6-7. The integration of computers into the Utah State University (USU) Coordinated Undergraduate Program (CUP) in dietetics is described. Among the applica­ tions taught are (a) nutritional analysis of diets, (b) appraisal of nutrient data bases, (c) menu plan­ ning for diabetic and weight control diets, (d) en­ teral and parenteral products analysis using patient profile data, and (e) statistical analysis. Addi­ tionally, senior students become involved in a theo­ retical project that requires them to evaluate the computing needs for a theoretical facility. The authors conclude that the variety of computer-related educational experiences provided in the USU-CUP pro­ gram enable students to appreciate and understand the capability of computers in the profession of dietet­ ics .

195.

Shoaf, Linda R. "A Computerized Resource Inventory." JOURNAL OF NUTRITION EDUCATION 16 (June 1984): 76A. A computerized inventory system to catalog the holdings of a dietetic internship library is de­ scribed. It was established with the collaboration of a staff librarian and a computer programmer. A coding system to categorize the various materials was developed. It includes codes for classifying materials according to title, author, publisher, owner, acquisition date, and subject area. Other useful information about journals and periodicals is incorporated into the system which can be adapted to meet the needs of other facilities.

196.

Short, Sarah H. "Media in Teaching College Level Nu­ trition." JOURNAL OF THE AMERICAN DIETETIC ASSOCIA­ TION 66 (June 1975): 581-587.

Higher Education

165

In a paper describing several innovative uses of communications media to teach human nutrition at Syracuse University, the author reported on a vari­ ety of ways in which computers were being used. The author described how a CAI program was developed. It was noted that students did not have to know how to program to participate in CAI sequences. The programs were available to the students from any of the hundred telecommunications terminals linked to the main computer at the Syracuse Campus. Noteworthy was the finding that self-instruction for an entire course in nutrition, using a variety of communications media (including audio tapes inte­ grated with film, slides, CAI, and workbooks), was well liked by students. Furthermore, the students thought it was effective and efficient. Many stated that they would recommend it to others. The author concluded that the use of CAI at Syracuse since 1969 had produced excellent results in learning nutrition. Short also described the introduction of computermanaged instruction (CMI) in the form of self-paced computer testing. It was planned so that each stu­ dent could take a quiz upon completing each learning module or whenever the student felt prepared to take it. Feedback was provided after each response. Upon completing each quiz, the student received a printout of the score and cumulative score on all tests. Ad­ ditionally, a list of objectives missed was included. The computer-managed tests consisted of multiplechoice, criterion-referenced questions. These were randomly generated from a question bank arranged by objectives. After two semesters of computer-managed testing, the number of students completing 90 to 100% of the objectives was much greater than the number of students in that range tested without the computer. Also, following those semesters during which the students began to test on the computer after completing each module, the number of "A" grades awarded increased sixteenfold. In sum, com­ puter-managed testing improved the instructor's management of a nutrition curriculum by providing immediate data about any student, the entire class, any question or group of questions, or any test at any time throughout the semester. Short concluded

166

Computer-Based Education

that the computer-managed program was extremely ef­ ficient in teaching college-level nutrition courses.

197.

Wade, Cheryl W . , and Victoria F. Thiele. "ComputerAssisted Instruction in a College Nutrition Course." JOURNAL OF NUTRITION EDUCATION 5 (October-December 1973): 246-248. One of the earliest experiments using computerassisted instruction (CAI) in a college-level nutri­ tion course was reported by these two members of the Department of Nutrition and Food Science at Syracuse University. Noting that CAI was still experimental and that good software was lacking, the researchers were notivated by the belief that CAI could be used as a teaching aid. Their experiment consisted of having two groups of students learn the same content about Federal packaging and labeling requirements for foodstuffs. Both groups were pretested and re­ ceived post-tests. One group (the control group) learned the content area using programmed instruc­ tion. The other (the treatment group) participated in the CAI sequence. All in all, there was no significant difference between the treatment (CAI) and the control group. Nonetheless, the authors reported that CAI proved to be an effective teaching supplement, particularly when the background knowledge of the students was varied. This was attributed to the branching capa­ bilities of CAI, which enabled students to skip those content areas they had already mastered. Addition­ ally, the computer allowed self-pacing to accommodate different learning rates. The authors also docu­ mented some aspects of the primitive technology of the era, exemplified by one subject’s comment that "too much noise coming from the terminal" made it difficult to concentrate.

PROFESSIONAL

198.

Maretzki, Audrey N., Elaine H. Asp, and Sandra K. Shimabukuro. "Conducting a Microcomputer Skills

Professional

167

Workshop for Nutrition Professionals." JOURNAL OF NUTRITION EDUCATION 17 (June 1986): 196B. Strategies are proposed for conducting a micro­ computer skills workshop for nutrition professionals interested in implementing computers in an educa­ tional setting. They developed the following objec­ tives for the workshop: (a) to teach how to develop a computer-assisted instructional program, (b) to demonstrate how to integrate computer-assisted in­ struction into a teaching program, (c) to teach how to make use of a variety of nutrition-oriented com­ puter-assisted instructional courseware for use with microcomputers, and (d) to evaluate nutrition-related courseware. After gathering a total of 17 microcomputer pro­ grams, participants were notified before the workshop to select four with which they would like to work. During the workshop, participants spent 30 to 40 min­ utes at microcomputer workstations working on pre­ workshop-selected software. Participants evaluated each program on a form provided, which Maretzki and associates published. Evaluations were shared by the participants. The workshop evaluations were mostly positive. Only the time alotted to certain topics was in dis­ pute as to relevancy. The value of this report cen­ tered around the authors’ expansion of McLaughlin’s (1984) recommendations to: (a) test all hardware and software prior to their use to determine their oper­ ational difficulties, operating time, and complexity; (b) place greater emphasis on nutrition software evaluation strategies, especially the application of criteria for evaluation; and (c) provide as much in­ dividualized instruction as time would allow.

199.

McLaughlin, Elaine C. ’’Considerations for Conducting a Microcomputer Workshop." JOURNAL OF NUTRITION EDUCA­ TION 16 (June 1984): 76H. A technical information specialist from the USDA’s Food and Nutrition Information Center listed eight considerations, and their rationale, to assist nutri­ tion educators in demonstrating software and conduct­

168

Computer-Based Education ing microcomputer-based training to target audiences: 1.

Establish specific objectives that can be met in one session.

2.

Create sessions tailored to the level of your audience.

3.

Use participatory learning strategies, limit­ ing the traditional lecture format.

4.

Plan the instructional environment based on the available equipment and anticipated group size.

5.

Among the greatest challenges is to achieve an appropriate participant-to-computer ratio.

6.

Anticipate needs. If installation of many microcomputers is required, consider staffing needs, responsibilities, electric power re­ quirements, layout, and setup.

7.

Display and/or distribute relevant reading lists, books, magazines, and circulars from software and computer distributors.

8.

Develop an information exchange network of contacts to continue participant training and exposure to software.

TEST-ITEM BANKS

200.

Nowacek, George A., and James W. Pichert. "An Item Bank of Diabetes-Related Test Questions." THE DIA­ BETES EDUCATOR 11 (Fall 1986): 37-41. The item bank concept can be extended to assist in patient care, counseling, and training situations in places where patient education programs are al­ ready in place. It is argued that a computerized item bank of diabetes test questions can save time in constructing tests for specific target audiences. This can be accomplished by taking advantage of

Test-Item Banks

169

computers and compatible software for entering, sort­ ing, and retrieving test questions; analyzing the re­ sults; revising items; and generating a printout con­ taining a master copy of the test for reproduction. A test item bank of diabetes-related questions is described, and procedures for requesting test ques­ tions from the item bank are included.

201.

Weinsier, Ronald L., C. Michael Brooks, John R. Boker, et al. "An Innovation in Nutrition Education: De­ velopment of a National Nutrition Test-Item Bank." 38 (November 1983): 795-799. An innovative use of computer technology in nutri­ tion education was the development and implementation of a prototype National Nutrition Test-Item Bank (NNTIB). It was conceived and developed at the Uni­ versity of Alabama-Birmingham (UAB) in order to val­ idly and reliably evaluate medical students’ knowledge of human nutrition. The test consisted of 1000 tech­ nically correct and scientifically accurate, multiplechoice items. Since the creation of a test-item bank was difficult and time-consuming, these researchers investigated the possibility of converting the system into a shared national resource. Five major issues were identified in the develop­ ment of this prototype test-item bank: (a) the devel­ opment of a classification system that would be used to store and retrieve test items, (b) the selection of test-item formats to standardize student assess­ ment procedures, (c) the formulation of content and technical standards with the assistance of faculty and educational consultants, (d) the test-item bank management system, and (e) a field test of the testitem bank. The researchers conducted a mail survey and work­ shop involving nationally renowned nutrition educators in order to seek guidance on the new test-item bank. Workshop participants recommended that the UAB bank should be modified and developed into a national test-item bank. Furthermore, they recommended that a national committee supervise the acceptance and re­ view of the items submitted to the NNTIB.

GLOSSARY

ADAPTIVE TEST:

An interactive computer-based examination in

which the level of complexity of the questions vary according to what the learner already knows about the subject matter. ALGORITHM:

A set of procedural steps or rules to be followed

sequentially to solve a particular problem or yield a particular result. APPLICATIONS PROGRAM:

A program or set of programs that

perform a particular specialized task, such as nutritional analyses, word processing, or spreadsheets. ARTIFICIAL INTELLIGENCE:

Computer systems that exhibit

characteristics commonly associated with human intelligence. These include understanding natural language, learning, problem-solving, and logical reasoning. AUTHORING:

The process of creating instructional software.

AUTHORING LANGUAGE OR SYSTEM:

A special type of programming

language developed specifically for the creation of instructional software. BAUD:

The rate at which information is transferred into or

171

Glossary

172

out of a computer.

It is the standard unit used to express

data transmission capabilities of lines, computer terminals, and interface equipment.

A 1200 baud rate means that data

transmission occurs at a rate of 1200 bits per second. BIBLIOGRAPHIC DATA BASE:

An information resource consisting

of citations of published journal articles, audiovisual materials, and books.

Two examples include Agricultural

Online Access (AGRICOLA) and Food Science and Technology Abstracts (FSTA). BIT:

Abbreviation for "binary digit."

It represents a digit

in the binary numeration system corresponding to 0 or 1 ("on" or "off"). BYTE:

The smallest unit of computer data.

A set of organized bits.

Unless otherwise indicated,

it is ordinarily assumed to be eight bits long.

A byte

usually represents one character, either a number or a letter. BOOT UP:

The transfer of a disk operating system program

from its storage on the disk to a computer’s working memory. BUG:

A hardware malfunction or software error.

CASE STUDY:

An instructional strategy that entails analysis

of the origin of a problem and the methods used in its solution.

It uses cumulative records of all available

relevant information.

In dietetics, case studies are used

Glossary

173

to teach students the role of diet in the treatment of various diseases. CATHODE RAY TUBE (CRT):

A video monitor similar in

appearance to a television screen.

As an output device,

it displays information from the computer on the screen. CENTRAL PROCESSING UNIT (CPU):

A set of electronic circuits

that direct the flow of information within a computer. It decodes machine language instructions and directs the hardware to execute them. CHARGE CAPTURING:

A data processing procedure in hospital

information systems designed to electronically gather cost data incurred by patients for various services.

In

dietetics, it is the process of collecting information on the total number of meals served and meal cost per patient. CHIP:

A single integrated circuit on a thin silicon wafer.

COMMUNICATIONS SOFTWARE:

Programs that contain the necessary

protocols to allow computers to communicate with one another through modems. COMPETENCY-BASED CURRICULUM:

An academic program designed

to enable students to achieve specific and precise outcomes that have been validated by the profession as being necessary for successful employment in the occupation for which the students are training.

174

Glossary

COMPUTER:

A device that can perform a sequence of logical

and/or arithmetical operations and yield useful results without human assistance, with the possible exception of preparing the device and setting it into operation. COMPUTER-ASSISTED INSTRUCTION:

The use of computers to

disseminate instructional materials.

Abbreviated "CAI."

Other synonymous terms include the following: CBE - Computer-based education CAL - Computer-assisted learning IAC - Instructional applications of computers CBI - Computer-based instruction CBT - Computer-based training COMPUTER-BASED COUNSELING SYSTEMS:

Interactive computer

systems programmed to advise patients on their nutritional concerns in health and disease. COMPUTER-BASED EDUCATION:

An instructional system that

stresses the use of computers to facilitate learning across the curriculum. COMPUTER-MANAGED INSTRUCTION (CMl):

Use of computers to

collect, compile, and manage information about a student’s progress.

Such information may include a pupil’s academic

standing, performance on tests, and grades. COORDINATED UNDERGRADUATE PROGRAM IN DIETETICS:

A

baccalaureate-level dietetics program accredited by the

Glossary American Dietetic Association.

175

Its main feature is that

theory is taught concurrently with practical correlated clinical experiences. COURSEWARE:

Software and accompanying materials specifically

used for instructional purposes. CURSOR:

An indicator light on the computer monitor screen

that shows where the next character should be placed. DATA BASE:

A store of filed data accessible by computer.

DATA BASE MANAGEMENT:

A filing system.

When computers are

involved, useful administrative functions may be performed, such as receiving, storing, manipulation, presentation, and storage of data. DATA PROCESSING:

The use of computers for clerical,

arithmetical, and logical manipulation of groups of characters representing a specified value or condition. DEBUG:

To correct hardware malfunctions or software errors.

DIET CHANGE NOTIFICATION:

Procedures following a change in

the diet prescription by an attending physician.

The

steps involved are to collect and record the information, and to inform the staff involved of changes regarding any restriction in a patient's diet. DIETETIC INTERNSHIP:

A thorough post-baccalaureate training

program approved by the American Dietetic Association, based in health care facilities and usually lasting a year.

176____ Glossary Interns are rotated through all phases of dietetics and thus become eligible to write the Registration Examination for Dietitians. DIETETIC SPECIALTIES:

The four areas of specialization

recognized by the American Dietetic Association that a graduate of an approved program may assume via completion of specified undergraduate studies.

These include general,

clinical, community, and management dietetics. DIETETIC TECHNICIAN:

Graduates of an American Dietetic

Association-approved, two-year, postsecondary curriculum in dietetics.

It is possible to specialize in either food

service administration or nutritional care. DIETETIC WORKSTATION:

A fully-equipped, state-of-the-art,

computer-based facility where a nutritionist is capable of performing comprehensive dietetic and nutrition operations such as assessing, planning, implementing, and evaluating the nutritional care of individuals in health and disease. DIETETICS:

A profession concerned with the art and science

of human nutritional care.

It includes dissemination of

knowledge about foods and nutrients to individuals throughout the life cycle in health and disease. DISK DRIVE:

A peripheral device that writes to, or reads

from, a magnetic disk, as directed by a computer program.

177

Glossary DOCUMENTATION:

A collection of documents that provide

information to the users of a computer system.

Types of

documentation include maintenance, user, and operating. DISK OPERATING SYSTEM (DOS):

The specific set of

instructions a computer needs in order to control input and output devices, record data, and acknowledge instructions. DRILL-AND-PRACTICE: A computer-based instructional strategy designed to supplement the regular teaching process.

The

computer provides regular review and practice of basic skills and concepts. ERGONOMICS:

The science that studies the physical needs of

people and reflects those needs in the design of equipment and workspaces.

It applies to the height of chairs and

tables, the distance from operator to video monitor, the placement of keyboards, and the brightness and resolution of video display units. EXPERT SYSTEM:

Computer programs that can be used to codify

the reasoning process of a specialist in a given discipline or area of study.

The computer is programmed

with a set of rules on how to reason and draw conclusions. On this basis it elicits information as required until it arrives at a conclusion. FEEDBACK:

Any message or display the computer presents after

178

Glossary a student completes a response.

It may take several forms

a simple "yes” or "no" response; an elaborate explanation of why the student's response is incorrect; animated graphics; or an evaluative statement of the student's performance. FILE:

Any organized and structured collection of information

FLOPPY DISK:

A flexible, plastic magnetic disk commonly used

as an inexpensive auxilliary memory storage device in computer systems. FOOD SELECTION FOR PURCHASING:

The procedures involved in

determining the kinds of food items that must be bought based on present stock levels, seasonal availability, food costs, forecasted needs, and delivery schedules. GRAPHICS: HARD COPY:

Pictorial or representational displays. The output on paper of the results of data

processing. HARDWARE:

A printout.

The mechanical, magnetic, electronic, and physical

components that make up a computer and its peripherals. Examples include terminals, disk drives, printers, and keyboards. IDEA PROCESSING SOFTWARE:

A software package designed as a

modeling base for ideas, strategies, objectives, and tactics.

It can be used to assist in generating,

developing, and evaluating ideas and strategies on the

179

Glossary computer screen.

It is presumably faster than traditional

pencil-and-paper strategies. IN-BASKET EXERCISE:

An instructional strategy incorporating

elements of realism while allowing the student to analyze and recommend a course of action to solve a complex (professional) problem. INPUT DEVICE:

Equipment that permits data and instructions

to be entered into a computer’s working memory,

including

light pens, optical character readers, and keyboards. INSTRUCTIONAL GAMES:

A computer-based learning strategy very

similar to simulations.

It may or may not imitate reality,

and involves entertainment, which simulations lack. Instructional games have been developed to teach a diverse number of subjects, including logical reasoning, vocabulary, and archeology. INTEGRATED SYSTEMS:

Configuration that involve computers

connected to other electronic technologies, such as computers combined with audio and/or video technology (e.g., videodiscs).

The result is an output that makes

use of the strengths of each technology. INTERACTIVE SYSTEMS:

A computer system in which an operator

and a computer can jointly execute some operations by means of initiating actions and responses.

180

Glossary

INTERACTIVE VIDEO-BASED FOOD FILES:

A computer system that

integrates videodiscs or other video output media designed to generate comprehensive pictures of all kinds of foods. With random access capabilities, the files may be an encyclopedic collection of food pictures useful in identifying foods or in menu planning. INTERFACE:

A program or device that enables one component

of a computer system to interact with another.

For

example, a computer and a printer connected together via an (interface) cable can produce hard copy documents. KILOBYTE (K):

1024 bytes; used to describe computer memory

storage capacity. KNOWLEDGE ENGINEERING:

The design and construction of

information systems. LANGUAGE (PROGRAMMING):

Programs designed to maximize or

minimize relationships that can be expressed as linear function.

Such programs are used to determine what is

the least number of food production workers to produce a full menu, of regular and modified diets, for 500 patients, at the least cost. MAINFRAME:

A large, general-purpose computer (compared with

a minicomputer or a microcomputer). MANAGEMENT INFORMATION SYSTEM (MIS):

A set of computer

programs and procedures designed to provide management

Glossary

181

with timely and relevant data to facilitate decision­ making . MEAL SCHEDULING:

The procedures involved in determining

the hours of service for each meal, considering such factors as the proximity of the client to the kitchen, type of meal service, and operating procedures. MEMORY CAPACITY:

The amount of information that a memory

device can store. MENU (COMPUTER):

Also referred to as storage capacity.

Usually an introductory display on a

computer monitor that lists computer user options. Selections are made using input devices. MENU (DIETETICS):

The list of foods that make up a meal

plan. MENU PLANNING:

The process of determining the components of

a meal plan, considering such factors as color, texture, nutritional adequacy, seasonal availability, budget, and the food habits of the target group. MERGING FILES:

Consolidation of any organized and

structured collection of information by computer. MICROCOMPUTER:

A small desktop computer that derives its

"intelligence” from a microprocessor. MICROPROCESSOR: MINICOMPUTER:

A CPU on a single silicon chip. A computer of intermediate size between a

mainframe and a microcomputer.

Glossary

182 MODEL:

A set of interrelated variable or factors which

together form elements symbolic of a working system. MODEM:

An abbreviation for modulator-demodulator.

It is a

device used for converting a digital signal into an analog signal.

In this way, the signal my be transmitted

along standard telephone lines. MONITOR:

A cathode ray tube similar to a television screen,

where output is displayed. MULTIPLE-CHOICE TEST:

An examination in which the learner

is presented with questions and a number of alternative responses.

The student must select the response that

(s)he thinks is the correct one. NETWORK:

A group of computers interconnected, usually by

telephone lines. NUMERIC DATA BASE:

An information source primarily concerned

with numbers and codes that cite statistical data or other forms of information.

Two examples include nutrient

data bases and the results of the National Household Food Consumption Survey. NUTRIENT ACCOUNTING:

A tally of the amounts of selected

nutrients in a food, menu, recipe, meal pattern, or other combination of foods. NUTRIENT ANALYSIS:

The process of determining the nutritional

composition of a food or foods, tallying the results, and

Glossary comparing them to a standard.

183

Then it is determined if

standards are met, not met, or exceeded. NUTRITION:

The study of foods and food constituents relative

to health. NUTRITIONAL CARE:

The creative process of translating the

bodies of knowledge of nutrition and other scientific fields to resolve food problems of humans. ONLINE:

A term applied to a computing system that provides

interactive data processing services at a location geographically distant from the computer that performs the processing. OPTICAL SCANNER:

A device that scans text or graphics and

generates digital representations for computer processing. OUTPUT DEVICE:

A device that converts data from bit patterns

stored in the computer to a form that can be used outside the computer system. PARADIGM:

A representation such as a model of a theory, a

principle, or an idea.

It may also be a procedural

pattern. PERIPHERAL:

In a computer system, any functional component

other than the central processing unit (CPU), including printers, disk drives, and video display terminals. PLAN IV REQUIREMENTS:

A set of competencies established by

the American Dietetic Association for entry-level

Glossary

184

dietitians.

These are used by undergraduate dietetics

education program directors to design or redesign their curricula. PRINTER:

The output device that converts electronic signals

into print on paper. PRINTOUT:

The printed paper output the computer generates

via a printer.

Also known as hardcopy output.

PRIVATE ACCESS WORKSTATION:

A fully-equipped, state-of-the-

art, highly user-friendly computer-based facility that may be used by the general public, either in the privacy of their homes or in workplaces, to acquire nutrition information. PROBLEM-SOLVING:

Systematic approaches to the solution of

difficult questions. PROCESS MANAGEMENT SOFTWARE:

A program that considers the

number of interrelated tasks required to execute a project during a specified period of time, and determines the critical path (schedule) co complete the project on time. PRODUCTION REPORT:

The procedures involved in compiling and

reporting statistics on the number of meals served, by type (breakfast, lunch, dinner) and by description (regular or modified diets).

Also, these procedures

involve important statistics such as food and labor costs,

Glossary

185

and the number of personnel involved in producing these meals. PROGRAMMING LANGUAGE:

An artificial language for writing

computer programs. PROTOTYPE:

An early and typical example.

PUBLIC ACCESS WORKSTATION:

A fully-equipped, state-of-the-

art, highly user-friendly computer-based facility, housed in public places such as libraries, shopping malls, or gyms, which may be used by the general public to acquire nutrition information. RANDOM ACCESS:

Refers to data stored in such a way that it

may be accessed individually at any memory location. RANDOM ACCESS MEMORY:

A type of memory that can be read

from or written to in random access fashion. REAL-TIME:

Refers to a situation in which computer processes

data while an operator at a remote terminal initiates a process.

Since there is minimal turnaround time, the

operator perceives no interruptions. REFERRAL DATA BASE:

An information resource that refers

users to current ongoing research in the United States. An example is the National Referral Center of the Library of Congress. RUN:

A single execution of a computer program.

186

Glossary

SCHOLAR'S WORKSTATION:

A fully-equipped, state-of-the-art,

computer-based facility designed to facilitate activities associated with the generation of new knowledge in human nutrit ion. SEQUENTIAL ACCESS:

A serial access of a file in which

records are presented for processing in the order in which they are stored. SIMPLE HELPS:

Prompts on the video display unit that enable

the user to proceed with using the software and/or coarseware. SIMULATION:

They may include cursors, windows, or arrows.

An analogy of a real-word situation or system

that may be studied in order to obtain information about the real system.

This instructional strategy enables the

learner to study systems that would otherwise be too dangerous, expensive, time-consuming, or untimely to study. SOFTWARE:

The instructions or set of programs used to direct

the operations of a computer or other hardware. SPREADSHEET:

An applications software package consisting of

a matrix organization that can process data, formulas, and text to perform such functions as financial planning and budgeting.

Using spreadsheet packages, it is possible to

construct highly complex models. STAND-ALONE MODE:

The ability of a computer to operate

independently of any other equipment.

For example, a

Glossary

187

workstation that can operate independently is called a stand-alone system. STORES INVENTORY:

The procedures involved in recording,

monitoring, and reporting the amounts of various foods and dietary supplies available for use by the institution at any given time. TELECOMMUNICATIONS:

The transmission and reception of data

in the form of electromagnetic signals through transmission lines or radio broadcasts. TIME-SHARING:

A means by which many persons can use a

computer system interactively and concurrently. TUTORIALS:

A computer-based learning strategy similar to

programmed learning in which the learner is led through the instructional sequence via a question and answer dialog.

The learner's mastery of the content is the entire

focus of instruction. USER-FRIENDLY:

Refers to software or courseware packages

that are easy to use. VIDEODISC:

A disc, usually plastic, containing recorded audio

and visual information designed for playback on a television monitor.

Its use is not limited to storage of

sound and pictures.

It is capable of storing large amounts

of text, or combinations of text, sound, graphics, and moving pictures.

This capability, coupled with random

188

Glossary

access, has prompted its experimental use in education and training. WORD PROCESSING:

The generic word used to describe programs

that produce text output.

Such programs also include a

number of text editing and formatting features that permit movement of blocks of text from one part of a document to another.

Printers are typically used with word processors

to generate hard copy.

AUTHOR INDEX

Abraham, Sidney, 5 Acosta, Phyllis B., 37 Adams, Elaine A., 134 Adams, J. Peter, 167 Adelman, Merril 0., 46, 93 Adlrich, Doris S., 69 Alford, Betty V., 20 Alster, Frances A., 144 Anderson, Ann L., 121 Anderson, Jennifer E., 94 Anderson, Kathryn, 37 Anonymous, 70, 114 Argo, Jana K . , 150, 151 Asp, Elaine, 143, 198 Azen, S .P., 103 Baer, Marion, T., 107 Balart, L ., 59 Balintfy, Joseph L., 1, 42, 63, 122 Ball, Marion, 71 Barrett, Joan, 170 Bassham, S., 80 Beach, Elizabeth, 115, 136, 158 Bell, Louise, 11 Bell, Stacey J., 30 Berenson, Gerald S., 21, 95 Bergalia, Joseph S., 123 Berrang, Clare, 154 Blackburn, George L., 30 Blackenhorn, D.H., 103

Bloom, Saul, 34 Bohn, Ellen, 93 Boker, John R., 201 Bratton, Barry D., 50 Breazeale, Steven P., 140 Breeses, Mary S., 152, 157 Brisbane, Helen M . , 14 Brooks, C. Michael, 201 Buckley, Donald C., 15 Bunton, Peggy W . , 16 Burk, Marguerite C., 7 Burnet, L.W., 90 Butrum, Ritva R., 33 Buxbaum, F., 58 Byrd-Bredbenner, Carol, 109, 178 Caceres, Cesar A., 5 Calloway, Doris H., 188 Canter, Deborah D., 158 Carew, Lyndon B., 144 Casbergue, John P., 60 Caster, W.O., 2, 145 Ceterski, Dorothy, 153 Chandler, Sarah J., 124 Chu, Chia-Lin, 181 Clark, Virginia A . , 26 Cleveland, Linda E., 3 Clithero, Wendell A., 81 Colucci, Antoinette L., 165 Corrozi, Ann M . , 154 Cotugna, Nancy, 154 Danford, Darla E., 12, 82 Dare, Doris, 17 Darling, Mary E., 176 De St. Jeor, Sachiko, 155 Dean, Judy, 49

189

190

Author Index

Dennis, Barbara, 18 Dennis, Lyman C., 63 Dennison, Darwin, 146 Dillon, James D., 56 Dow, Ruth M . , 156 Dowdy, Richard P., 100 Doyle, Mary K. , 53 Driscoll, Daniel L., 192 Dubin, Stephen, 43, 181 Duddleson, William G., 24 Duering, Gail, 194 Duford, Sally T., 182 Dunphy, Marlys K. , 50 Dwyer, Johanna T., 72, 93 Eckstein, Eleanor, 61 Eisele, Jill, E., 164 Elmer, P .J ., 27 Elvin, David W . , 144 Endres, Jeannette, M . , 8, 106 Ernst, Nancy, 18 Evans, Sue N ., 19 Fanslow, Alyce M . , 163 Farris, Rosanne P., 21, 95 Findorff, Irene K., 63 Fisher, Sarah, 140 Fletcher, L.R., 80 Flook, Marion G., 20 Ford, Margaret G., 125 Forester, J. Darlene, 186 Fowler, Karen D., 116 Foytik, Jerry, 4 Frank, Gail C ., 21, 95, 110 Frank, Robyn C., 73 Frauenheim, Kathryn A., 146 French, Arthur B., 24 Fromm, Barbara, 62 Galvin, Marianne, 30 Gaurth, Hansen R., 32, 36 Gebhardt, Susan E., 33

Gelpi, Mary Jane, 63 Gerace, Terence A., 22 Gilmore, Shirley C., 163 Glatky, Carlton B., 29 Goodloe, Mary Helen, 38 Goodwin, Cleon W . , 28 Gordon, Barrow J., 38 Gordon, Joan, 143 Gormican, Annette, 19, 25 Grambsch, V., 18 Granell, Julie, 147, 148 Graves, Nancy, 165 Gremillion, L., 59 Guley, Helen M . , 135 Hander, Edwin 0.., 28 Hayes, Olive, 5 Helbig, Lillian C., 69 Heldman, Dennis R., 168 Hemmen, Theresa E., 96 Hepburn, Frank N., 97 Hertzler, Ann A., 23 Hicks, Zita R., 64 Hjortland, Marthana, 18, 24 Holmes, Zoe A., 169, 170 Hoover, Loretta W., 23, 51, 56, 62, 67, 68, 74, 83, 84, 98, 99, 100, 101, 102, 121, 124, 126, 128, 132, 141, 159, 160, 161, 162, 166, 183 Houghton, G.E., 172 Hsu, N. , 25 Hughes, Karla V., 100 Hunt, Isabelle, 26 Isu, Leighton, 146 Jackson, Anne, 43 Jacobs, Stanley E., 71 Johnson, Nancy E., 27 Johnson, R.L., 103 Johnson, Ruth A., 133 Johnson, V., 126 Judd, Joseph T., 44 Kasavana, Michael L., 117 Katch, F.I., 6 Katch, V.L., 6 Kennedy, Barbara, 37 King, Janet C., 188

Author Index Knehans, Allen W. , 52 Knight, John B., 165 Koch, Joan, 165 Kowaloff, Holly, 34 Kozlowski, Betty W . , 107 Kudsk, Kenneth A., 15 Lakness, Jean A., 53 Lambee, Maureen, 184 Lambert, Carolyn U., 136 Lancaster, Lilly M., 1, 42 Law, Patricia B.M., 185 Lee, Eugene C ., 150, 151 Leonard, Michael S., 74 Lin, Chiong, 181 Lopes-z, A . , 59 Lowder, William, 127 Luke, Larry S ., 26 Maloff, Tania, 85 Manchester, Katharine E., 75 Maretzki, Audrey N., 198 Marshall, Marta, 170 Marshall, Mary W . , 44 Maruyama, Fudeko F., 186 Mason, M . , 31 Matthews, M.E., 76 Mattson, Melody L., 176, 177 McCool, Audrey C., 118 McCracken, Karen, 115 McLaughlin, Elaine C., 199 McLaurin, Nancy K. , 28 McLellan, Mark R., 171 McMurray, Pamela, 141 McNaughton, Robert, 169 Medill, Carolyn, 127

191

Messersmith, Ann M . , 128, 134 Meylor, Donice J., 51 Millar, Roger, 155 Miller, Linda G., 54 Mo, Amy, 29 Moe, Glenna R ., 68 Molleson, Ann, 187 Moore, Aimee N. , 62, 67, 68, 121, 124, 128, 129, 132, 133, 159, 160, 161, 162 Moore, M.C., 59 Mulvaney, S.J., 172 Murphy, Elizabeth W . , 33 Murphy, Norma J., 26 Murphy, Suzanne P., 188 Mutschler, Mary, 130 Natta, Larry, 139 Njus, Helen P ., 163 Norback, J.P., 76 North, Barbara, 153 Norton, L. Charnette, 124 Nowacek, George A., 200 Oexmann, Mary J., 45 Okos, M.R., 173 Orser, Jean, 130 Orta, John, 86, 189, 190 Osterman, Dean, 169, 179 Otradovec, C .L., 93 Ours, Patricia, 47, 180 Pao, Eleanor M . , 7 Pasulka, Patrick, 30 Payne, Judith S., 182 Pearson, Thomas E., 77, 165 Peckos, Penelope, 29 Pelican, Suzanne, 109, 110, 178, 183 Pellegrino, Thomas W., 119 Perloff, Betty P. , 99, 101, 102

Pfeffer, Andrea, 3 Pichert, James W., 200 Pitts, Vikki, 191 Pope, Joan E ., 123 Porter, Carol, 24 Porter, Douglas, 55, 58 Quinlan, Carrol, 38 Randall, Elizabeth, 104

192

Author Index

Rastkar, A. , 126 Ratliff, Ronald A., 52 Reklaitis, G.V., 173 Ries, Carol P., 147, 148 Rizvi, S .S.H., 172 Rochford, Connie C., 87 Roe, Daphne A . , 41 Rogan, Anne, 105 Rose, Barry S ., 15 Russell, Gerald F., 174 Sager, Jane F ., 75 Sager, R.A., 111 Sawicki, Marjorie, 8, 106 Sawyer, Carol A., 120, 165 Schaum, Kathleen D., 31, 78, 149 Schimpfhauser, Frank, 152 Schroeder, Lois A., 192, 193 Schvaneveldt, Noren B., 194 Seltser, Raymond, 88 Selzer, D.H., 103 Sempos, Christopher T., 27 Shanklin, David, 106 Sharp, Joan L., 31, 78 Shick, Gay L ., 67 Shimabukuro, Sandra K., 198 Shoaf, Linda R., 195 Shoemaker, James F., 174 Short, Sarah H., 142, 196 Short, William R., 142 Sifferman, Christine K., 166 Slack, Warner, 34, 55, 58 Slavin, Joanne L., 112, 176, 177

Smicklas-Wright, Helen, 178 Snyder, Oscar, P., 137 Sorenson, Ann W. , 32, 88 Spears, Marian C., 65 Stare, F ., 58 Steefe, James F., 175 Steefe, James F., 168 Stinson, Joel P., 135 Suitor, Carol W . , 46, 72 Suitor, Richard F., 46 Swider, Cynthia, 180 Sze, Melanie C., 79 Taub-Dix, Bonnie, 113 Taylor, Martha, 107 Thiele, Victoria F., 193, 197 Thompson, Ethel M . , 9 Tillotson, Jeanne, 18 Timmons, Kathryn H., 182 Torrence, Barbara L., 138 Tucker, Henry, 9 Tuthill, Byrdine H., 66, 129 Tyler, Frank H., 155 Vaden, Allene G., 65, 138 Vassar, Mary Lynn, 115 Vogel, S., 58 Wade, Cheryl W., 197 Waller, A.L., 126 Warriner, William J., 56 Waters, Grady, 38 Watson, Donna R., 150, 151 Watt, Bernice T., 33 Weathers, Barbara J., 56 Webber, Larry S., 95 Weiher, John, 181 Weinsier, Ronald L., 201 Welch, Ann C., 152, 157 Wesley, Neil W., 125 Wheeler, Gloria, 179 Wheeler, Lawrence A., 47, 48, 57, 91, 180 Wheeler, Madelyn L., 47, 48, 57, 91, 180 Wilcox, Marianne M . , 132 Willard, Robin, 89 Willey, Dawn, 112 Williams, C .S ., 90

Author Index Williams, Sue R., 13 Wilson, Anita, 112 Windham, Carol T., 108 Witschi, Julia, 34, 55, 58 Wittwer, Arthur J., 32 Wood, Steven D., 131 Woods, Margo, 93 Woteki, C .E ., 10 Wyatt, Jan, 39, 40 Wyse, Bonita W . , 32, 35, 36, 88 Yarbrough Al-Bander, Susan, 17 Yon, Bethany A., 144 Youngwirth, Joni, 92 Yu, Stella, 105 Zears, Hilda, 85 Zemel, Paula, 148 Zitzka, Claudia A., 28

193

TITLE INDEX Caveat Emptor: Assessing Needs, Evaluating Computer Options, 72 Choosing a Computerized Nutrient Analysis, 113 Choosing a Diet Analysis System for Classroom Use, 188 Client’s Comprehension of a Computer-Analyzed Dietary Intake Printout, 178 Clinical Dietitians Use Computer-Generated Worksheets, 51 College-Level, ComputerAssisted Course in Nutrition, 144 Comparative Study of Two Nutrient Data Bases, 106 Comparison of Dietary Intake by Two Computerized Analysis Systems, 21 Computer and the School Lunch Program, 61 Computer Applications for the Foods and Nutrition Professions: The State of the Art, 86 Computer Applications in a Coordinated Undergraduate Program, 194 Computer Applications in Clinical Dietetics in Canada: Why Should We Recreate the Wheel?, 11 Computer Applications in Clinical Nutrition, 12

Analysis of Dietary Data: An Interactive Computer Method for Storage and Retrieval, 34 Analysis of a Microcomputer Program for Clinical Dietetics, 153 Analysis of Meal Census Patterns for Forecasting Menu Item Demand, 124 Anthropometric and Computerized Tomographic Measurements of Lower Extremity Lean Body Mass, 15 Authoring a CAI Lesson in Nutrition Education, 148 Automated Diet Construction for Clinical Research, 45 Automated Hospital Information System Functions for Dietetics, 74 Automated Purchasing: Forecasts to Determine Stock Levels and Print Orders, 132 Automatic Calculation for the Renal Diet, 43 CAI in College-Level Nutrition Education: A Feasibility Study, 147 Calculated vs. Analyzed Composition of Four Modified Fat Diets, 44 Case.History of a Hospital Information System, 70

195

196

Title Index

Computer Applications to Med­ ical Nutrition Problems, 82 Computer as a Dietetic Tool, 81 Computer Experiences in Food and Nutrition Cooperative Extension Programs, 176 Computer in Retrieving Die­ tary History Data. I. Designing and Developing a Computerized Diabetic Dietary History, 19 Computer in Retrieving Die­ tary History Data. II. Retrieving Information by Summary Generation, 25 Computer Methods in Nutri­ tional Analysis: A Proto­ type Undergraduate Course for Dietetic Students, 189 Computer Nutrition Services: A Guide to Selection, 96 Computer Simulation for Pro­ duction Scheduling in a Ready Food System, 135 Computer Software for Nu­ trition Support Services: Needs Analysis and Product Assessment, 30 Computer Systems for Food­ service Operations, 117 Computer Systems in Health­ care: A Glimpse of the Future and the Role of a Resource Center, 77 Computer Technology in In­ stitutional Foodservice, 118 Computer Technology to Eval­ uate Body Composition, Nutrition, Exercise, 6 Computer Use for Nutrition Majors, 145 Computer Use in a Nutrition Course for Elementary Education Majors, 182

Computer-Aided Design and Operation of Food Process in Industry and Academia, 173 Computer-Assisted Approach to Meal Patterning, 7 Computer-Assisted Drafting Makes its Mark in Food­ service, 139 Computer-Assisted Food Man­ agement Systems, 129 Computer-Assisted Instruc­ tion Course, 197 Computer-Assisted Instruc­ tion for Decision Making in Food Systems Manage­ ment, 158 Computer-Assisted Manage­ ment, 65 Computer-Assisted Personnel Data System for a Hospital Department of Dietetics, 67 Computer-Assisted Personnel Data System for a Hospital Department of Dietetics, 68 Computer-Assisted Revision of a Community Diet Man­ ual, 53 Computer-Assisted Weight Control Program, 52 Computer-Based Decision Support System Aids Dis­ tribution in Planning and Control of Foodservices, 64 Computer-Based Dietary Counseling System, 58 Computer-Generated Fiscal Reports for Food Cost Accounting, 62 Computer-Generated Graphic Evaluation of Nutritional Status in Critically In­ jured Patients, 28 Computer-Graphic Method of Teaching Protein Chemical Score Concepts, 181

Title Index Computer-Implemented Nutri­ tion Support of Phenylke­ tonuria, 37 Computer-Managed Clinical Evaluation System: Impli­ cations for CompetencyBased Dietetic Education Programs, 151 Computer-Managed Instruction System Applied to Dietetic Education, 150 Computer-Managed Subsistence System: A Look at a Model Feeding System of the Future, 137 Computer-Planned Menus: A Prospective Diet Assess­ ment Method, 57 Computer-Selected Exchange Lists Approximations for Recipes, 47 Computer-Simulated Clinical Encounters: Case Flow and Program Content, 157 Computer-Simulated Clinical Encounters: Development, Utilization, and Evalua­ tion of a Program, 152 Computer-Simulated Experi­ ments in Food Science: Part II: Evaluation of the Model in Use, 170 Computer-Simulated Labora­ tory Experiments in Food Science: Part I: The Model, 169 Computer-Tallied Menu System, 130 Computerized Clinical Dietetics Management Systems, 56 Computerized Diet Analysis System for the Research Nutritionist, 17 Computerized Dietary Analysis Systems: A Comparative View, 93

197

Computerized Dietary Order Entry System, 50 Computerized Feedback and Recipes for Family Daycare Providers, 179 Computerized Foodservice Management— Bibliography for Classroom Use, 164 Computerized Fortune-Tellers Forecast the Future of Foodservice, 114 Computerized Hospital Infor­ mation Systems and the Department of Dietetics, 71 Computerized Interviewing System for the Obese, 54 Computerized Learning for Clinical and Nonclinical Students, 192 Computerized Menu Printing System Reduces Clerical Tasks, 123 Computerized Nutrient Data Bases: I. Comparison of Nutrient Analysis Systems, 98 Computerized Nutrient Data Bases: II. Development of Model for Appraisal of Nutrient Data Base System Capabilities, 99 Computerized Nutrition Counseling in a Coordinated Undergraduate Program, 154 Computerized Nutritional Analysis System for Burn Care, 39 Computerized Resource Inven­ tory, 195 Computerized Scheduling for Cook/Freeze Food Production Plans, 136 Computers in Dietary Studies, 9 Computers in a Dietary Study, 29 Computers in Dietetics, 89

198

Title Index

Computers in Dietetics: The State of the Art, 1976, 84 Computers in Epidemiologic Dietary Studies, 5 Computers in Food Service, 120

Computers in Nutrition, 85 Computers in Nutrition, Dietetics and Foodservice Management, 83 Computers in the Management of Nutritional Practice, 13 Computers in Undergraduate Food Science Education— A Survey, 175 Computing "Best Fit" CalorieControlled Diet Patterns by Microcomputer, 1 Computing Menu Nutrients by Data Processing, 14 Concepts for the Future... School Food Service and the Computer, 60 Conducting a Microcomputer Skills Workshop for Nu­ trition Professionals, 198 Consequences of Utilizing Re­ duced Nutrient Data Bases for Estimating Dietary Adequacy, 100 Considerations for Conduct­ ing a Microcomputer Workship, 199 Cost Comparison of Systems for Nutrient Analysis— Computer vs. Manual Cal­ culation, 20 Course in Computer Technology for Food Science Students, 174 Descriptive Sales Slip: A Dietary Assessment Tool on the Horizon, 22 Development of a ComputerAssisted Program for Under­ graduate Instruction, 143

Development of a Dietary In­ take Monitoring System for Nursing Homes, 27 Development of an Automated Form Generating System for Menu Item Data, 121 Development of Computer-Based Process Control Experiments for a Food Engineering Course, 172 Development of Food Tables and Use with Computers, 23 Development of On-Line RealTime Menu Management System, 126 ’Dietan'— A Computer-Assisted Program on Anatomy and Nu­ trition, 187 Dietary Interviewing by Com­ puter, 55 DIETETIC COM-PAK, 159 DIETETIC COM-PAK: Instructors Guide, 160 DIETETIC COM-PAK: Student Guide, 161 DIETETIC COM-PAK: Technical Guide, 162 Dietitians Improve Patient Care with Computerized Selective Menu, 125 Dietitians Use Computer As­ sistance to Contain Costs,

66 Digital Computer in Research Dietetics, 155 DINE Microcomputer Program: An Innovative Curriculum Approach, 146 E.D.P. Recipe Adjustment by Percentage Method in a College Foodservice System, 138 Educational Application of Computers: A Descriptive Study of Home Economics Educators in American Col­ leges and Universities, 185

Title Index

199

Educational Uses of Computer Innovation in Nutrition Edu­ Models for Food Freezing cation: Development of a Processes, 168 National Nutrition TestEducational Uses of Compu­ Item Bank, 201 ters: Hardware, Software, Inquiry into Computer Appli­ and Strategies, 141 cations in Dietetics, 87 Energy and Nutrient Calcula­ Integrated Nutrition and tions Using an Optical Food Cost Control by Com­ Character Reader System, 8 puter, 63 Energy and Nutrient Values Introduction to Computerfrom Different Computerized Based Process Control in a Data Bases, 107 Food Engineering Course, Evaluating Foodservice Soft­ 171 ware: A Suggested Approach, Inventory and Cost Control 116 by Computer, 133 Evaluation of Computer-Based Item Bank of Diabetes-Related Education in Persons with Test Questions, 200 Diabetes Mellitus and Low-Cost Nutritious Diet Plans— A Commentary, 10 Limited Educational Back­ ground, 180 Media in Teaching College Evolution of Computers in Level Nutrition, 196 Meeting the Information Needs Dietetics: A Review, 92 of Food Scientists Through FASTEX: Computing Best Fit Computerized Literature Individualized Exchange Searching, 79 Patterns, 42 Menu Planning by Computer, Food Composition Tables for 122 the 1970s, 33 Micro-Computer Assisted De­ Future Applications of the velopment of Nutrition Edu­ Microcomputer in Dietetics, cation Materials, 191 90 Microcomputers Energize and Guidelines for Selecting a Exercise Programs, 177 Dietary Analysis System, 110 Model for the Comprehensive Guidelines for Use of Compre­ Use of Computers in Nutri­ hensive Foodservice Software tion Education, 190 Systems in Academic Set­ Model for the Review of Nu­ tings, 165 trient Data Base System Implementing a Comprehensive Capabilities, 101 Foodservice Computer System, Model for the Review of Nu­ 115 trient Data Base System In-Basket Exercise to Teach Capabilities. 2d ed., 102 Computer-Assisted Food Sys­ Model for Statistical Fore­ tems Management, 166 casting of Menu Item De­ Index of Nutritional Quality mand, 131 for a Balanced Diet, 32 Multi-Echelon Menu Item Fore­ Information Resources for casting System for Hospi­ Food and Human Nutrition, 73 tals, 128

200

Title Index

NHLBI Nutrition Data System, 18 New Approach to the Design of Information Systems for Foodservice Management in Health Care Facilities, 76 Nutrient Analysis of ’Ex­ change Lists for Meal Plan­ ning.' Part I: Variation in Nutrient Levels, 35 Nutrient Analysis of 'Ex­ change Lists for Menu Planning.' Part II: Nu­ trient Density of Food Profiles, 36 Nutrient Analysis Systems— A Computerized Seven-Day Food Record System, 103 Nutrient Data Bases— Con­ siderations for Educators, 183 Nutrient Estimates from Com­ puterized Questionnaires vs. 24-hr. Recall Inter­ views, 26 Nutrient Menu Planning for Clinical Research Centers, 48 Nutrition Message and the Medium, 142 Patient-Oriented Dietetic Information System. 1. A Computerized Menu Print and Diet Order System, 78 Patient-Oriented Dietetic Information System. 2. Compiling a Computerized Nutrient Data Bank, 31 Patient-Oriented Dietetic Information System. 3. A Computer-Assisted Instruc­ tion Program for Calculat­ ing Nutrient Intakes, 149 Personal Computers for Health, 88

Planning Diets to Meet the National Research Council's Guidelines for Reducing Cancer Risks, 3 Planning High-Carbohydrate, High-Fiber Diets with a Microcomputer, 46 Predictions of the Cause, Ef­ fects, and Prevention of Drug-Nutrient Interactions Using Attributes and Attri­ bute Values, 41 Programs with Color, Sound and Graphics, 186 Proposed Army Hospital Food Service Data Processing System, 75 Punch Cards Simplify Selec­ tive Menus, 127 Quality Controls for Proces­ sing Dietary Data, 95 Regionalizing a National Nu­ trient Data Base, 104 Renal Diet Therapy— A Com­ puter-Assisted Instruction Model, 193 Review of Computing in U.K. Dietetics, 80 Review of Microcomputer Nu­ trient Analysis and Menu Planning Programs, 91 Robots in Food Systems: A Review and Assessment of Potential Uses, 134 Selected Bibliography on Computers in Education, 140 Selecting a Computer-Assisted System for Food Service, 119 Sequential Procedure for Implementing a ComputerBased Information System, 69 Serum Lipids, Dietary In­ takes, and Physical Exer­ cise in Medical Students, 59

Title Index

Simulations Teach Management and Nutrition Counseling Skills, 156 Software: How Do You Choose?, 109 Software Program Teaches Concept of Nutrient Den­ sity, 184 Software Search: A Dilemma, 111

Some Problems with Nutri­ tional Analysis Software, 105 Some Problem-Solving Tech­ niques Applied to Nutrition Education Software, 163 Statistical Analysis in a Food Science and Engineer­ ing Laboratory Course, 167 Studies in Atherosclerosis, 4. Electronic Computers in the Processing of Dietary Data, 38 Support Materials for Nu­ trient Analysis Programs, 94 Take the Proper fBytef when Selecting Microcomputer Nutrient Analysis Software,

112 U.S.D.A. National Nutrient Data Bank, 97 U.S.D.A.fs Nutrient Data Bank, 108 Update: Computerized Nutri­ tion Analysis in a Burn Center, 40 Use of a Digital Computer in the Study of Eating Habit Patterns, 2 Use of Computerized Medical Records, 49 Using the Computer as a Referral Source to Find the Patient at Risk, 16

201

Using the Computer to Calculate Nutrients in Metabolic Diets, 24 Very Low-Cost Nutritious Diet Plans Designed by Linear Programming, 4

SUBJECT INDEX Absenteeism, record of, 68 Academic achievement, 170 Acne, 154 Adaptive computer-based nutrition education, 190 Additives, 7 Administrative applications, 70, 85, 90, 92 Administrative dietetics, 66, 92, 129 Administrative dietitians, 66, 84, 135, 136, 167 Administrative function, 30, 92 Admissions, 71 Affective competencies in dietetic education, 158 Agricultural economics, 10 Agricultural experiment stations, 33 Agriculture Canada, 11 Allergies, 70 Alternative scenario appraisal, 64 American Dietetic Association's Management Bibliography for Dietetic Practioners, 164 Analog input devices, 172

Analysis of considerations for establishing a computer-based curriculum, 190 Analysis of dietary data, 5, 34, 58, 93, 95, 149 Analysis of meal census patterns, 124 Analysis of nutrient intake, 17, 66, 78, 82, 91, 93, 149 Analysis of recipes, 155 Analytic software, 183, 188 Analytical methodologies, 108 Animated graphics, 186 Anthropometric assessment, 12, 15 Applications of computers to food service problems, 127 Appriasal of nutrient data bases, 194 Arguments to justify establishment. of a Computerbased curriculum, 190 Army hospital food service, 75 Assessing nutritional status, 123 Assessment of nutritional quality, 32 Atherosclerosis, 38 Athletic training, 146 Attitudes towards working with computers, 192 Audiovisual materials, 147 Authoring a computer-assisted instructional lesson in nutrition education, 148 203

204

Subject Index

Authoring systems, 141, 148, 163 Automated calculations, 34, 43, 45, 48 Automated diet construc­ tion, 43, 45 Automated Form Generat­ ing System, 121 Automated menu tallying system, 130 Automated payroll sys­ tems, 117 Automated purchasing, 132 Automation of the die­ tary department's pro­ cedures, 123 Back office systems, 117 Balanced diet, 32 Baseline data, 22, 101 BASIC, 145 Basic nutrition course, 146 Bedside monitoring, 12, 28 Behavioral change, 54 Behavioral objectives, 150 Benedictines, 38 Benefits of using com­ puters in instruction, 141 Beverage control sys­ tems, 117 Bibliographic data bases, 73 Bibliography on computers in dietetics, 82 Bibliography on computers in education, 140 Bibliography on computers in food service manage­ ment, 82, 164 Bibliography on computers in nutrition, 82 Biochemical assessment,

12

Body composition, 6, 12, 52 Bogalusa Heart Study, 95 Bomb calorimetry, 44 Branching capabilities, 144, 187, 197 Burn care, 39, 40 Burned patients, 28, 39, 40 Business management in clini­ cal practice, 13 Calculating nutritive value of diets, 9 Calculation of nutrient in­ takes, 11, 82 Calculation of recipe nu­ trients, 101 Calorie-consumption com­ pliance, 180 Calorie-restricted diet, 121 Calorie-to-nitrogen ratio, 28 Canadian Nutrient File, 11 Cardiac rehabilitation, 146 Cardiovascular disease, 5, 152 Case studies, 157 Cash register configurations, 117 Catering, planning and con­ trol, 77 Central nutrient file system, 11

CEREAL, 176 Charge capture, 56, 74 Charting, 12 Chase Econometrics, 114 Chemical analyses, 33 Choosing a computerized nu­ trient analysis system, 113 Client services, 118 Clinical activities, 158 Clinical assessment, 12 Clinical care in the hospital setting, 13 Clinical courses, 150 Clinical dietetics, 11, 86, 92, 153 Clinical dietetics in Canada, 11

Subject Index Clinical dietitians, 51, 84 Clinical encounters, 157 Clinical experiences, 152, 158 Clinical instructors, 152 Clinical investigations, 41 Clinical nutrition, 12, 86 Clinical nutritionist, 125 Clinical observations, 41 Clinical research, 30, 45 Clinical situations, 152 Coding menu data, 121 Coding procedures, 34 Cognitive competencies in dietetic education, 158 Cognitive skills, levels of, 156 College education, 12 College food service, 84, 138 College nutrition class­ room, 147 Combination diets, 70 Communications media to teach human nutrition, 196 Community diet manual, 53 Comparison of computer­ ized diet analysis sys­ tems, 21, 91, 93, 95, 98, 106, 107 Competency-based cur­ riculum, 150, 151 Competency-based die­ tetic education pro­ grams, 151 Complex simulations, 156

205

Compressed data bases, 34, 100

Computational methods of nu­ tritional analysis soft­ ware, 101 Computational validity, 101 Computer applications across the curriculum, 190 Computer applications in a coordinated undergraduate program, 194 Computer applications in clinical nutrition, 12 Computer applications in dietetics, 87, 129, 189, 190 Computer applications in education, 140, 141 Computer applications in healthcare food service management, 129 Computer applications in nu­ trition, 85, 190 Computer capabilities, 156 Computer experiences, 154 Computer graphics, 86, 181, 191 Computer graphics packages, 191 Computer language, high-level, 172 Computer management problem simulations, 156 Computer methods in nutri­ tional analysis, 189 Computer misuse, 88 Computer models for food freezing processes, 168 Computer nutritional analysis techniques, 189 Computer operating systems, 117 Computer simulation for pro­ duction scheduling in a ready food system, 135 Computer simulations, 156, 169, 170

206

Subject Index

Computer systems for food service operations, 117 Computer systems in healthcare, 77 Computer technology for food science students, 174, 175 Computer technology in institutional food service, 118 Computer use for nutrition majors, 145 Computer use in nutri­ tion course for ele­ mentary education majors, 182 Computer-aided design, 172 Computer-aided opera­ tion of food proces­ ses in academia, 172 Computer-aided opera­ tion of food proces­ ses in industry, 172 Computer-analyzed dietary intake printout, 178 Computer-assisted col­ lege-level nutrition education, 143, 147 Computer-assisted draft­ ing (CAD), 139 Computer-assisted educa­ tion based on food freezing, 168 Computer-assisted food management system, 129, 159, 160, 166 Computer-assisted fore­ casting system, 124 Computer-assisted in­ struction (CAI), 12, 92, 144, 147, 149, 158, 168, 187, 193, 196, 197, 198 Computer-assisted in­ struction for calcu­ lating nutrient

intakes, 149 Computer-assisted instruction in a dietetic education program, 158 Computer-assisted instruction in simulating personnel management decision-making, 158 Computer-assisted instruc­ tional courseware, nutri­ tion-oriented, 198 Computer-assisted instruc­ tional design techniques, 148 Computer-assisted instruc­ tional program on anatomy and nutrition, 187 Computer-assisted lessons, 158 Computer-assisted management, 65, 75, 166 Computer-assisted manufac­ turing (CAM), 139 Computer-assisted menu plan­ ning, 57, 63, 85, 91, 143 Computer-assisted methodology to generate a master menu,

121 Computer-assisted methodology to generate food order re­ ports, 121 Computer-assisted methodology to generate food production forecasts, 121 Computer-assisted methodology to generate food production worksheets, 121 Computer-assisted methodology to generate food usage forms, 121 Computer-assisted methodology to generate master copies of selective menus, 121 Computer-assisted personnel data system, 67, 68 Computer-assisted production control, 121

Subject Index Computer-assisted weight control program, 52 Computer-based ap­ proaches, 180 Computer-based course in food service sys­ tems management, 165 Computer-based curricu­ lum, 190 Computer-based curricu­ lum, administrative factors, 190 Computer-based curric­ ulum, financial con­ siderations, 190 Computer-based curric­ ulum, hardware issues, 190 Computer-based curric­ ulum, professional development, 190 Computer-based curric­ ulum, software issues, 190 Computer-based curric­ ulum, support per­ sonnel, 190 Computer-based deci­ sion support system, 63 Computer-based dietary counseling, 58, 90, 154, 180 Computer-based die­ tetic information system, 89 Computer-based econo­ metric models, 114 Computer-based educa­ tion, 192 Computer-based educa­ tion in persons with diabetes mellitus, 180 Computer-based educa­ tional technologies, 192

207

Computer-based information retrieval systems, 175 Computer-based information system (CBIS), 69, 71, 74 Computer-based instruction, 172, 192 Computer-based instructional programs, 186 Computer-based instructional sequence, 148 Computer-based instructional sequence, evaluation of, 148 Computer-based instructional sequence, formatting for optimal screen presentation, 148 Computer-based instructional sequence, initial planning, 148 Computer-based instructional sequence, planning inter­ action, 148 Computer-based instructional sequence, programming, 148 Computer-based instructional sequence, selection of teaching methods, 148 Computer-based instructional sequence, writing text, 148 Computer-based instructional strategies, 193 Computer-based instructional system, 192 Computer-based learning ex­ periences, 163 Computer-based learning sys­ tems for the home, 86 Computer-based menu management system, 126 Computer-based menu order sys­ tem, 123 Computer-based method for forecasting menu item demand, 131 Computer-based nutrition edu­ cation, 148, 180

208

Subject Index

Computer-based process control, 171, 172 Computer-based process control, development of, 171 Computer-based process control workstation, 172 Computer-based ques­ tioning strategies, 103 Computer-based selec­ tive menu system, 123 Computer-based simula­ tions, advantages of, 156 Computer-based simula­ tions, analysis of student thought pro­ cesses, 156 Computer-based simula­ tions, application of cognitive mate­ rials, 156 Computer-based simula­ tions, disadvantages of, 156 Computer-based simula­ tions, evaluating skills, 156 Computer-based simula­ tions, review of cognitive materials, 156 Computer-based statis­ tical package, 167 Computer-generated data, 75 Computer-generated documents, 132, 160 Computer-generated evaluations, 192 Computer-generated fiscal reports, 62 Computer-generated graphic evaluation of nutritional

status, 28 Computer-generated nutrient equivalent lists, 155 Computer-generated nutritional analysis, 27, 80, 93, 95 Computer-generated printout, understanding by older adults, 178 Computer-generated records, 25 Computer-generated reports, 66, 160 Computer-generated reports, interpretation of, 160 Computer-generated slide material, 191 Computer-generated worksheets, 51 Computer-graphic method of teaching, 180 Computer-managed clinical evaluation system, 151 Computer-managed evaluation system, 151 Computer-managed instruction applied to dietetic educa­ tion, 150 Computer-managed instruction (CMI), 144, 148, 150, 193, 196 Computer-managed instruction, "content-free," 150 Computer-managed instruction, evaluation strategies, 150 Computer-managed instructional system, 150 Computer-managed subsistence system, 137 Computer-managed tests, 196 Computerization of dietetic procedures, 78 Computerization of the food service department, 115 Computerized clinical die­ tetics management system, 56 Computerized clinical simula­ tions, 152

Subject Index Computerized diet anal­ ysis, 26, 29, 72, 80, 85, 91, 93, 98, 103, 105, 112, 121, 149, 153, 188 Computerized dietary analysis system for educational purposes, 188 Computerized dietary collection system, 18 Computerized dietary history, 19, 25, 54, 58 Computerized Dietary Order Entry System, 50 Computerized feedback, 179 Computerized food pro­ duction scheduling model, 136 Computerized food service management bibliography, 164 Computerized inter­ viewing, 54, 55, 90 Computerized inventory system to catalog library holdings, 195 Computerized item bank, 200 Computerized learning for clinical stu­ dents, 192 Computerized learning for nonclinical stu­ dents, 192 Computerized literature searching, 79 Computerized medical records, 49, 71 Computerized menu print system, 78, 123

209

Computerized nutrient analy­ sis software, 113, 153, 188 Computerized nutrient data bank, 31, 97, 106 Computerized nutrient data bases, 23, 82, 97, 106 Computerized nutritional analysis applied to food service operations, 120 Computerized nutritional analysis procedures, 105, 188 Computerized patient data base, 50, 85 Computerized questionnaires, 26 Computerized resource inven­ tory, 195 Computerized scheduling for cook/freeze food production plan, 136 Computerized selective menu, 125 Computerized tomography, 15 Computer-mediated case study, 157 Computer-printed menus, 125 Computers and medical nutri­ tion problems, 82 Computers as a dietetic tool, 80, 105 Computers as a research tool, 79, 90 Computers as a useful in­ structional tool, 181 Computers in dietetics, 84, 89, 92 Computers in undergraduate food science education, 175 Computers transmit informa­ tion, 154 Computer-simulated clinical encounters, 152, 157 Computer-simulated laboratory experiments in food science, 169, 170

210

Subject Index

Computer-tallied menu system, 130 Computer-to-computer data communication system, 176 Computer-video inter­ faces, 86 Computing in the U.K., 80 Computing menu nu­ trients, 14 Computing techniques in food systems man­ agement, 160 Concept of protein complimentarity, 180 Conducting a microcom­ puter skills workshop for nutritional pro­ fessionals, 199 Constant diets, 48 Consultation function, 30 Consumer education, 12 Content accuracy of instructional soft­ ware, 109 Content validity, 151 Continuing education, 92 Control of food serv­ ices, 64, 76 Conventional menu plans, 63 Cooperative extension programs in foods and nutrition, com­ puter experiences in, 176 Coordinated under­ graduate program (CUP) in dietetics, 49, 152, 155, 158, 194 Cost analysis, 60 Cost comparison of systems, 20, 111

Cost control, 65 Cost control by computer, 63, 65, 66 Cost effectiveness of com­ puterized reports, 68 Costed standardized recipes, 66 Counseling patients, 123, 155, 180, 200 Counseling process, 34, 58, 90, 123, 156 Counseling skills, 156 Courseware, 141 Criterion-referenced ques­ tions, 196 Daily diet census, 50, 70, 130 Daily management reports, 50 Data analysis, 166 Data base access, 86 Data base accuracy, 99 Data base appraisal, model for review of its capabilities, 98, 99, 101, 102 Data base capabilities, 99, 101

Data base comparability, 97 Data base creation, 67 Data base design, 67 Data base, large, 100 Data base maintenance, 56, 67, 93, 188 Data base management, 188 Data base performance, 99, 101 Data base, regionalization, 104 Data base reliability, 72, 97, 98 Data base size considerations, 100

Data base, small, 100 Data base status, 101 Data base update, 67, 72 Data base validity, 72, 82, 95, 97, 98 Data bases, inferior, 88 Data cards, 103 Data communications, 71, 176

Subject Index Data comparability, 6 Data files, 162 Data input, 67, 71, 81 Data interpretation, 166 Data manipulation, 62 Data output, 95 Data processing, 9, 14, 67 Data processing con­ cepts, 117 Data sorting, 67 Data storage, 62, 71, 90 Data transfer, 174 Debugging educational software, 163 Decision-making appli­ cations, 70, 143, 158 Defining computing needs, 119 Defining the require­ ments of a computer system, 119 Demographic analysis, 134 Dental caries, 26 Descriptive sales slip, 22 Designing educational software, 163 Designing evaluation strategies, 150 Designing nutrition software programs, 163 Desktop calculators, 9 Developing nutritional care plans, 123 Development of a standardized recipe data file, 129 Diabetes diet counsel­ ing, 180, 200 Diabetes education, computers enhance ef­ fectiveness of, 180

211

Diabetes mellitus, 19, 25, 42, 46, 47, 55, 57, 154, 180,

200 Diabetic diets, 42, 64 Diabetic management, 146 Diagnosis of eating problems, 34 Diagnosis-related groups (DRGs), 64 Didactic courses, 150 Diet analysis printouts, 178 Diet and health, 186 Diet change notification, 74 Diet history, 26, 59 Diet instructions, 46, 58 Diet inventory of nutritional experience (DINE), 146 Diet order Kardexes, 78 Diet plan, 10 Diet prescriptions, 46, 49, 50, 52, 57, 70, 80, 123, 193 Diet tray assembly, 70 DIETAN, 187 Dietary adequacy estimation, 100

Dietary analysis, 9, 17, 27, 80, 85, 91, 93 Dietary assessment, 12, 22, 27, 57, 72, 80 Dietary evaluation, 8, 34 Dietary intake monitoring, 27 Dietary intakes, 59 Dietary manipulations, 45 Dietary records, 8, 72, 82, 95, 101, 103 Dietary studies, 9 Dietary survey data, 2 DIETETIC COM-PAK, 159, 160, 161, 162, 166 DIETETIC COM-PAK, instructor's guide, 160 DIETETIC COM-PAK, student guide, 161 DIETETIC COM-PAK, technical guide, 162 Dietetic educators, 166

212

Subject Index

Dietetic internship, 12, 150, 151 Dietetic software, 189 Dietetics services, 129 Dietitian’s management role in computerassisted systems, 166 Dietitian’s management role in computerassisted systems, data analysis, 166 Dietitian’s management role in computerassisted systems, data interpretation, 166 Dietitian's management role in computerassisted systems, establishing priorities, 166 Dietitian’s management role in computerassisted systems, preparation of operational data, 166 Dietitian's management role in computerassisted systems, problem solving, 166 Dietitian’s management role in computerassisted systems, staffing, 166 Digital computers, 2, 19, 154 Digital computers in research dietetics, 155 Digital input devices, 172 Digital logic, 174 Digital output devices, 172 DINE microcomputer program, 146 Discharges, 71

Documentation manuals, 188 Drill and practice, 109, 193 Drug-nutrient interactions, prevention of, 41 Eating patterns, 2, 4, 103, 145 EATS, 178 Econometric models, 114 Educational applications of computers, 185 Educational software, 176 Educational strategies for computer-assisted instruction, 120 Educational technology, 156 Educational uses of computers, 141, 168 Efficiency of the medium, 109 Electronic bulletin board, 154 Electronic technologies, 142 Employee productivity data, 70, 84 Employee seniority, 68 Employment history, 67 Endocrine diseases, 152 Energy calculations, 8 Energy expenditure levels, 52 Energy-yielding nutrients, 107 Enteral feeding, 39 Enteral products analysis, 194 Epidemiologic dietary studies, 5, 15, 20 Equipment demands, 136 Error correction, 109 Estimates of diet category census, 128 Estimates of menu-item demand, 128 Ethnic diversity, 104 Evaluating a computer-assisted food service system,119 Evaluating a new Computerassisted system for food service, 119 Evaluating computer options, 72

Subject Index Evaluating food service software, 116 Evaluating system problems, 119 Evaluation of nutritional status in critically ill patients, 28, 39 Evaluation of student performance, 165 Evolution of computer applications in nutrition and dietetics, 86, 92 Exchange Lists for Meal Planning, 1, 35, 36, 42, 47, 57, 180 Exercise, 6, 52,54, 59, 177 Exercise programs, 177 Experimental diets, 44 Extreme values, 95 Factors affecting dietary selection, 9, 10 Factors in selecting a diet analysis system, 17, 72, 91, 96, 188 Faculty monitoring, 152 FAST FOOD, 176 FASTEX, 42 Feasibility study, 119 Feedback, 150, 151, 163, 179, 193, 196 Feedback, appropriate, 193 Feedback, immediate, 193 Financial assessment, 48 Financial management, 65 FITCOM, 6 Flow of nutrition education, 190 Flow sheet ofserial data, 30

213

FOOD$, 176 Food choice decisions, 143 Food composition data, 72, 97 Food composition, regional differences, 104 Food composition, seasonal differences, 104 Food composition tables, 23, 24, 33, 88 Food consumption patterns, 100, 103, 104 Food consumption records,2, 38 FOOD COST, 176 Food cost accounting, 62, 65, 84, 129, 159, 161 Food enrichment standards, 183 Food frequency questionnaires, 22 Food habits, 25 Food industry, 33, 134, 176 Food in6ake, 7 FOOD INTAKE ANALYSIS (FOINANA), 176 Food inventory control, 48, 60, 65, 71, 74 Food item file, 138 Food ordering system, 138 Food preferences, 10, 25, 45, 46, 54, 61, 70, 130, 131 Food preparation techniques, 103 Food production control systems, 129 Food production forms, 126 Food production problems, 135 Food production scheduling, 131 Food production systems, 136 Food science, 32, 174, 175 Food selection, 74 Food service applications, 92, 118, 120 Food service director, 70 Food service industry, 114, 117

214

Subject Index

Food service information systems, 117 Food service management information systems, 62, 66, 76 Food service managers, 65, 118 Food service operations, 62, 66, 117 Food service software systems in academic settings, 165 Food service software systems in univer­ sity curriculum, 165 Food service systems, 131 Food sources of nu­ trients, 186 Food systems manage­ ment curriculum, 129 Food-measuring skills, 180 Food-related policies, 104 FOODS, 149 FOODS AND NUTRITION BULLETIN BOARD SYSTEM (BBS), 176 Foods composition data base, 27, 31, 33, 34 Forecast errors, 128 Forecasting, 77, 131 Forecasting food pro­ duction requirements, 124 Forecasting menu item demand, 124, 128 Forecasting model, 131 Forecasts sheets, 126 FORTRAN, 47, 85 Full-time equivalents,

66 Future of computers in the discipline, 12, 76, 77, 84, 90, 114

Gastrointestinal diseases, 152 Geographic diversity, 104 Graphic representation of nu­ tritive data, 36 Graphics capabilities, 181 Hardening of the arteries, 38 Hardware compatibility, 111 Hardware constraints, 177 Hardware decisions, 188 Hardware incompatibility, 1 Hardware requirements, 112, 162 Hardware selection, 69, 115, 188 Hardware selection for class­ room use, 188 Health education, 88, 146 HEALTH-AIDE analytical soft­ ware, 153 HEALTHY EATING, 176 Heart disease, 7, 38, 59, 95 High-carbohydrate diets, 46 High-fiber diets, 46 History of computers in edu­ cation, 141 History of computers in food service, 120 Home economics educators, in American Colleges and Uni­ versities, 185 Home economics educators, personal use of computers, 185 Home economics educators, pro­ fessional use of computers, 185 Home health care, 12 Hospital admission data, 51 Hospital department of die­ tetics, 67, 68 Hospital food service data processing system, 75 Hospital formulary, 157 Hospital information system, 70, 71, 74 Hospital information systems in dietetics, benefits of, 71

Subject Index Hospital-based situa­ tion, 157 Human factor issues, 13 Human relations process, 156 Hypercholesterolemia, 46 Hyperlipoproteinemia, 56 Hypertriglyceridemia, 46 Implementing a compre­ hensive computer sys­ tem, 115 Implementing a computerassisted system for food service, 119, 129 Implementing a computerbased information sys­ tem, 69 Implementing computer application in die­ tary departments, 87 Implementing computers in an educational set­ ting, 198 Improvement of nutri­ tional status, 49 Imputed values, 97 In-basket exercises, 166 Index of Nutritional Quality (INQ) con­ cept, 32, 36 Index of relative pro­ tein quality, 43 Indirect costs, 72 Individual prefer­ ences, 6 Individualization of instruction, 193 Individualization of nutrition education, 143 Individualized diets, 46

215

Individualized exchange pat­ terns, 42 Individualized instruction, 147, 150 Individualized menus for patients, 123 Information access, 73 Information in machine-readable form, 73 Information management in dietary departments, 64, 66 Information resources, 73 Information retrieval, 73, 79 Information services, 73 Ingredient files, 77 Ingredient room, 115 INQ calculations, 32 Institutional menu development, 145 Institutional menu modifica­ tion, 145 Instructional programmer, 152 Instructional simulations, 166 Instructional software, 148, 165, 177, 184, 197 Instructional system, 144 Instructional techniques, 187 Integrated computer-video in­ terfaces, 103 Integrated nutrition and food cost control, 63 Integrated technologies, 86 Interactive computers, 156 Interactive diet analysis sys­ tem, 17, 80, 82 Interactive diet construction, 45 Interactive optical videotape system, 156 Interactive retrieval system, 34, 64 Interactive simulations, 193 Interactivity, 6, 147 Interactive Foodservice De­ cision Assist Methods (IFDAM), 64

216

Subject Index

Interpretation guides,

101, 102 Interpretation of printouts of nutri­ tional analysis pro­ grams, 72, 94, 105 Inter-rater reliabil­ ity, 151 Intervention trials,

22 Interview techniques, 12, 19 Interviewing skills, 34 Interviewing tech­ niques, 150 Intravenous regimens, 80 Introductory foods and and nutrition course, 147 Inventory, 115, 132, 33, 136, 159, 161, 165 Inventory and cost control by computer, 133 Inventory areas, 115 Inventory control, 132, 133, 159, 161, 165 Inventory control sub­ system, 161 Inventory management, 77, 132, 133, 165 Job Control Language, 162 Joint Commission on the Accreditation of Hospitals, 53 Keyboard, 70 Knowledge base manage­ ment system, 41 Knowledge disseminators, 190 Knowledge generators, 190 Labeling requirements, 197

Labor accounting reports, 68 Labor cost, 66, 68 Labor demands, 136 Labor scheduling, 165 Laboratory computer systems, 175 Laboratory Instrument Computer (LINC), 19 Lacto-vegetarian, 38 Large-scale studies, 38 Layout and design, 60, 84, 164 Lean body mass, 15 Linear programming, 4, 10 Literature searches, 33 Local networks, 175 Long-range planning, 71, 76 Long-term diets, 48 Low-cost nutritious diet plans, 10

Mail order diet analysis serv­ ice vendors, 72, 96 Mainframe computer, 47, 80, 118, 145 Management control techniques, 164 Management decisions, 66 Management information func­ tions, 118 Management information systems, 62, 66, 74, 89 Management of nutritional practice, 12 Management problem simulations, steps in development, 156 Management reporting, 56 Management control theory, 164 Managerial decision-making, 62, 76, 158 Managerial skills, 158 Man-machine interface, 85 Manual forecasting techniques, 128 Manual versus computerized diet calculations, 20, 26 Mark sense readers, 150 Master menu, 126 Master Menu File, 126

Subject Index Master personnel and attendance files, 67 Matrix data structures, 64, 76 Meal frequency, 7 Meal patterns, 1, 7 Meal scheduling, 74 Media teaching in col­ lege level nutrition, 196 Media technologies, as educational tools, 142 Media technologies, as professional tools, 142 Medical dietetics, 152, 187 Medical history, 25 Medical records, 70, 82, 157 Medical terminology, 150 Menu audits, 126 Menu calendar, 115 Menu engineering, 77, 117 Menu item forecasting system for hospitals, 128, 132 Menu planning, 48, 57, 58, 60, 61, 63, 64, 70, 71, 74, 77, 85, 91, 143 Menu planning as a mathematical problem, 63 Menu planning simula­ tions, 143 Menu pricing, 64 Menu printout, 70 Menu selections, 130 Menu tally, 70 Menu-related functions, 118 Menus, 115 Metabolic diets, 24

217

Microcomputer architecture, 174 Microcomputer data base man­ agement system, 111 Microcomputer nutritional analysis software, 189 Microcomputer program for clinical dietetics, 153 Microcomputer software, 46, 72, 82, 88, 101, 112, 163, 176, 177, 189 Microcomputer technology, 171, 182, 188 Microcomputer workstations, 188, 199 Microcomputer-assisted develop ment of nutrition education materials, 191 Microcomputer-assisted in­ struction, 176 Microcomputer-based training, 199 Microcomputers, 27, 37, 39, 41, 46, 47, 80, 82, 88, 90, 91, 101, 111, 112, 118, 144, 145, 148, 171, 172, 174, 176, 177, 182, 184, 188, 189, 191, 198, 199 Microcomputers as professional tools, 189 Microcomputers skills workshop 198 Microcomputers, unique capa­ bilities of, 184 Microcomputers used to teach nutrition, 177, 182 Micronutrient shortcomings, 105 Minerals, 107 Minnesota Education Computing Consortium (MECC), 176 Model for the comprehensive use of computers in nutri­ tion education, 189 Modified diets, 44, 150 Modified fat diets, 44 Multi-diet systems, 63

218

Subject Index

National Heart, Lung, and Blood Institute (NHBLI), 18, 103 National Nutrition Test-Item Bank (NNTIB), 201 Needs analysis, 30, 72 Nitrogen balance, 28 Normal nutrition, 86 Novel food products, 184 Numeric data bases, 73 Nursing card index, 157 Nursing homes, 27 Nursing station, 70, 71 NUTACC, 53 Nutritional analysis software, associated problems, 105 Nutrient accounting, 183 Nutrient Analysis Sys­ tem (NAS), 103 Nutrient catalogue, 157 Nutrient composition of foods, 183 Nutrient constraints, 48 Nutrient content of diets, 149 Nutrient Data Bank Con­ ference, 88 Nutrient Data Bank (NDB), 33, 97, 108 Nutrient data bank, steps in establish­ ing, 33 Nutrient data base, 17, 82, 85, 112, 149, 183 Nutrient data bases, considerations for educators, 183 Nutrient data bases, inherent limitations, 183

Nutrient data bases, inter­ system variability, 82 Nutrient data bases, potential sources of error, 183 Nutrient data bases, potential sources of variability, 183 Nutrient data bases, verifi­ cation of accuracy, 97 Nutrient Data Research Branch of the Human Nutrition Infor­ mation Service, USDA, 108 Nutrient data sources, 82, 101 Nutrient density concept, 184 Nutrient density of food pro­ files, 32, 184 Nutrient evaluation, 145 Nutrient files, 11 Nutrient intake pattern, 7, 82 Nutrient requirements, 45 Nutrient sources from foods, 72 Nutrient supplementation recom­ mendations, 26, 105 Nutrient syllabi, 126 Nutrient-controlled diets, 48 Nutrition counseling, 13, 26, 77, 90, 103 Nutrition course, upper-level, 145 Nutrition curriculum, 147, 196 Nutrition education, 13, 84, 85, 86, 88, 90, 100, 147, 154, 163, 182, 189, 190 Nutrition education, collegelevel, 147, 182 Nutrition education, problems, 190 Nutrition educators, 183 Nutrition for the athlete, 186 Nutrition information via com­ puter-assisted, interactive videodisc system, 180 Nutrition labeling, 97 Nutrition prescription, 30, 37, 42, 80 Nutrition research, 13, 72, 90

Subject Index Nutrition software eval­ uation strategies, 198 Nutrition software pack­ ages, 111 Nutrition support serv­ ices, 30 Nutrition support soft­ ware , 80 Nutrition surveys, 13 Nutritional analysis, 13, 20, 35, 36, 39, 47, 48, 53, 58, 60, 66, 71, 72, 74, 84, 85, 88, 91, 93, 94, 95, 98, 103, 109, 112, 115, 145, 153, 183, 188, 194 Nutritional analysis printouts, content, 96, 188 Nutritional analysis software, 72, 82, 88, 91, 93, 94, 101, 105, 109, 110, 112, 145, 153, 183, 189 Nutritional analysis software, potential misuse of, 105, 189 Nutritional assessment, 165 Nutritional care, 13, 51, 84, 123, 150, 152, 157 Nutritional care man­ agement, 152 Nutritional care plans, 13 Nutritional care prob­ lems, 152 Nutritional care pro­ cess, assessment, 150 Nutritional care pro­ cess, evaluation, 150 Nutritional care pro­ cess, implementation, 150

219

Nutritional care process, planning, 150 Nutritional composition, 143, 183 Nutritional content, 63 Nutritional management of endstage renal disease, 192 Nutritional quackery, 105 Nutritional quality index of foods, 32 Nutritional quality of diets, 32 Nutritional requirements of burn patients, 39, 40 Nutritional risk, 16 Nutritional risk list, 16 Nutritional support for the thermally injured patient, 39 Nutritional support in the critically ill, 28 Nutritional therapy, 13, 15, 103 Nutrition-related courseware, 198 Nutritive value information, 33 Nutritive values of foods, 33, 81 Obesity, 7, 54, 55, 154 Omnivores, 93 Online computer configuration, 63, 67, 71 Online menu management system, 126 Operational aspects of using computers in food service,

120 Operational efficiency, 77 Operations research techniques, 135 Operator-sensitive software, 77 Optical Character Reader (OCR) technology, 8, 86 Optional recipe files, 77

220

Subject Index

Palatability con­ straints, 9, 10, 63 Parenteral feeding, 39, 80 Parenteral product an­ alysis, 194 Patient care, 84 Patient census data, 78 Patient census fore­ casting, 128 Patient education, 72, 84 Patient inquiries, 56 Patient nutrient intake analysis, 159 Patient nutrient intake subsystem, 161 Patient-computer dia­ logues, 58 Patient-oriented die­ tetic information sys­ tem, 31, 78, 149 Percentage of weight change, 28 Personal computers for health, 88 Personalized computerprinted menus, 78 Personnel management, 158, 164 Personnel management administration, 164 Phenylketonuria, 37 Physician’s orders, 71 PKU CALC, 37 Planning clinical diets, 32, 46 Planning diet instruc­ tions, 25 Planning diets, 3, 46, 55 Planning for computerbased operations, 92 Planning instruction, 49 Planning nutritional care, 12

Planning of food services, 64, 76 Point of sale support, 77 Potassium-restricted diet, 155 POWER PACKED NUTRITION, 184 Precosting, 117, 165 Pre-surgical diets, 49 Printed output, difficulties with, 72, 81, 82, 94 Problem-solving skills, 152, 163, 169 Problem-solving technique ap­ plied to nutrition education software, 163 Process control, development of computer-based, 172 Process engineering, 173 Processing dietary data, 38 Procurement information, 164 Product assessment, 30 Production areas, 115 Production control, 65, 77, 129, 159, 161 Production control subsystem, 151 Production forecasting, 84 Production functions, 118, 165 Production problems, 135 Production reports, 74 Production worksheets, 130 Productivity, 131 Professional Activities Survey, (PAS), 49 Professional education, 160 Professional resistance, 13 Program planning, 13, 76 Programmable calculators, 27, 43 Programmer, 148 Programming language, 121 Progress notes, 71 Prospective pricing and reim­ bursement in hospitals, 64 Protein-calorie malnutrition, 15 Pseudo-nutritionists, 105 Purchase order generation, 66

Subject Index Purchasing, 60, 74, 77, 115, 165 Purchasing areas, 115 Purchasing functions, 118 Purchasing system, 115 Quality controls for processing dietary data, 95 Quasi-health practioners, 88 Question bank, 196 Quick Input of Fbods program, 34 Raw food cost, 63 Real-time menu manage­ ment system, 126 RECALL, 176 Recipe control, 77 Recipes, 115 Recommended Dietary Allowances, miscon­ ceptions, 178 Recommended Dietary Al­ lowances (RDAs), 3, 48, 53, 72, 105, 178 Record-keeping feature, 144 Reduced nutrient data base utilization, consequences of, 100 Referral data bases, 73 Remediation, 144 Remote terminals, 71 Renal component of diet therapy, 192, 193 Renal diet therapy, a computer-assisted model, 193 Renal dietitian, 193 Renal diets, automatic calculation of, 43 Renal nutrition, 193 Reported nutrient in­ takes, 26, 82, 106 Representative data base, 104

221

Representativeness of 24-hour recall, 22, 26 Research applications, 90 Research data, 95 Research dietitians, 48, 155 Research diets, 24 Research nutritionist, 17 Restricted diets, 49 Retrospective studies, 49 Robotic implementation, 134 Sampling techniques, 108 Scheduling, 84, 165 School food service, 61, 83 Selecting a computer-assisted system for food service, 119 Selecting appropriate food service software, 116 Selecting microcomputer nu­ trient analysis software, 112, 145 Selective menus, 48, 127 Self-instruction for an entire course in nutrition, 196 Self-instructional package, 193 Self-paced computer testing, 196 Self-paced instruction, 197 Sensory attributes, 143 Serum lipids, 59 Seven-day nutrient intake data, 103 Simulated laboratory experi­ ments in food science, 169 Simulation software, 160 Simulations, 109, 152, 156, 160, 166, 169, 193 Simulations teach counseling skills, 156 Simulations teach management skills, 156 Single topic questions, 154 Social history, 25 Socioeconomic characteristics, 7 SODIUM AND YOU, 176 Sodium-restricted diets, 121

222

Subject Index

Software and hardware compatibility, 72, 111, 198 Software characteristics, 110, 111, 172 Software documentation, 109 Software evaluation, 109 Software, low quality, 88 Software packages for data analysis, 175 Software selection, 69, 72, 96, 109, 110, 111, 112, 141 Software systems in academic settings, 165 Specialized Center of Research-Arteriosclerosis (SCOR-A), 95 Spiraling costs, 66 Statistical analysis, 100, 167, 194 Statistical analysis in a food engineering laboratory course, 167 Statistical analysis in a food science course, 167 Statistical analysis in a food science laboratory course, 167 Statistical analysis of variance, 100 Statistical forecasting of menu item demand, 131 Statistical forecasts, 128, 131 Stock levels, 132 Storage functions, 118 Student dietitians, 154 Student's clinical skills, 157

Sugar crystallization, 169 Summaries of dietary intakes, 155 Supervisory personnel, 125 Supplemental feedings, 72 Supplementary teaching materials, 148 Support materials for nutrient analysis software, 94, 109 System selection, 119, 141 Systematic integration of computer-assisted instruction into a dietetic program, 158 Systems analyst, 125, 152 Systems dietitians, 138 Teaching, 30 Teaching diet therapy, 192 Teaching environment, 165 Teaching tools, 181 Teaching-learning process, 150 Telecommunications systems, 86 Telecommunications terminals, 196 Termination records, 67 Test item-bank, 200, 201 Test item-bank, diabetesrelated questions, 200 Testing format, 187 Test-item bank, national nutrition, 201 Test-item bank, prototype, 201 Test-item formats, 201 Texas regional nutrient data base, 104 Text-based program, 144 Therapeutic diets, 46 Thrifty Food Plan, 4 Time-sharing configuration, 30 Toxicity, 7 Training, 200 Transfers, 71 Trappists, 38 Turnover index by work area, 68 Tutorial, 193 Twenty-four-hour food record, 178

Subject Index Undergraduate course for dietetic students on computer methods in nutritional analysis, 189 Undergraduate instruc­ tion in food science, 175 Universal coding system, 81 Usage sheets, 126 USDA AGRICULTURE HAND­ BOOK NO. 8, 53, 59, 97, 102, 108 USDA Child Care Food Program, 179 USDA Consumer Nutrition, Center, 97 USDA Nationwide Food Consumption Survey, 3, 7, 100 USDA Nutrient Data Base, 104, 108 USDA Nutrient Data Re­ search Branch of the Human Nutrition Infor­ mation Service, 108 Vegetarians, 93 Vegetarianism, 147 Vendor's proposals, 119 Veterans Administration Hospitals, 14 Video display output, 103 Video matrix terminal, 71 Video-based foods li­ brary, 103 Videodiscs, 103, 180 Videotapes, 156 Weight control, 154 Weight loss, 54, 55 Wellspring Project, 154 WHAT I USUALLY EAT, 163

223

JOURNALS

American Journal of Clinical Nutrition Annual Journal of Dietetic Software 1986-1987 Communications of the ACM Diabetes Care Diabetes Educator Dietetic Currents Drug-Nutrient Interactions Environmental Nutrition Food & Nutrition News Foodservice Equipment Specialist Food Technology Health Education Human Nutrition: Applied Nutrition Institutions Journal of Dietetic Software Journal of Nutrition Education Journal of Parenteral and Enteral Nutrition Journal of the American Dietetic Association M.D. Computing Modern Hospital Preventive Medicine Professional Nutritionist School Lunch Journal School Food Service Research Review Topics in Clinical Nutrition

225

OUTLINE OF CONTENTS COVERING MAJOR AREAS OF DIETETICS AND NUTRITION

NORMAL NUTRITION

I.

Energy A. Energy Metabolism 1. Sources of energy a. Food sources b. Tissue stores 2. Cellular oxidation 3. Forms of energy expenditure a. Basal metabolism b. Voluntary physical energy c. Specific dynamic action 4. Measures of energy utilization a. BMR b. PBI c. Weight control d. Calorimetry B.

Units of Measurements 1. Kilocalories 2. Kilojoules

C.

Variability of Energy Needs 1. Age, activity, and sex differences 2. Specialized requirements a. Athletic performance b. Occupational environments

D.

Hormonal Control of Metabolism 1. Insulin-Glucagon 2. Thyroxine 3. Epinephrine 4. Growth hormone

227

228

Outline of Contents E.

II.

Regulation of Food Intake

Nutrients (1) Physical and chemical properties; (2) Food sources; (3) Functions; (4) Dietary requirements; (5) Recommended allowances; (6) Deficiencies of the following: A.

Carbohydrate

B.

Protein

C.

Lipids

D.

Vitamins 1. Lipid soluble a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K 2. Water soluble a. Thiamin b. Riboflavin c. Niacin d. Folic acid e. Vitamin (Pyridoxine) f. Vitamin B12 (Cyanocobalamine) g. Pantothenic h. Vitamin C (ascorbic acid) i. Biotin j. Inositol k. PABA (Para-aminobenzoic acid)

E.

Minerals 1. Calcium 2. Phosphorus 3. Iron 4. Magnesium 5. Zinc 6. Iodine 7. Fluorine 8. Copper 9. Selenium 10. Manganese 11. Chromium 12. Sodium 13. Potassium 14. Sulfur

Outline of Contents III. IV.

V.

229

Water, Electrolyte, and Acid-Base Balance Digestion and Absorption A. GI Tract 1. Structure 2. Secretions 3. Functions B.

Purposes of Digestion

C.

Types of Digestion 1. Chemical 2. Mechanical 3. Bacterial

D.

Digestability of Foods

E.

Mechanisms of Absorption 1. Passive diffusion 2. Active transport

F.

Sites of Nutrient Absorption

G.

Controls of Absorption (enzymes, hormones, etc.)

H.

Absorption of: 1. Carbohydrate 2. Protein 3. Lipids 4. Vitamins 5. Minerals 6. Water

Cellular Metabolism A. The Cell 1. Structure 2. Function B.

Carbohydrate Metabolism

C.

Protein Metabolism

D.

Lipid Metabolism

E.

Vitamin Metabolism

F.

Mineral Metabolism

Outline of Contents

230 VI.

VII.

VIII.

IX.

Body Composition A. Compartments of the Body B.

Somatotypes

C.

Body Weight Standards

D.

Determining Body Composition

Dietary Guides and Their Uses A. Recommended Dietary Allowances B.

U. S. RDAs and Nutrition Labeling

C.

Food Groups

D.

Tables of Food Composition

Meal Patterns and Food Habits A. Meal Planning and Budgeting B.

Environmental Influences on Food Habits 1. Socioeconomic 2. Physiological 3. Cultural

C.

Vegetarianism

D.

Influence of Athletics and Physical Fitnes s Programs on Food Patterns

E.

Influence of Faddism on Food Patterns

Nutritional Needs Throughout the Life Cycle A. Pregnancy and Lactation B.

Infancy

C.

Childhood

D.

Adolescence

E.

Adulthood

F.

Elderly

Outline of Contents

231

CLINICAL NUTRITION

I.

II.

Assessment of Nutritional Status of Individuals A. Dietary Information B.

Physical Findings

C.

Laboratory Measurements

Nutritional Management of Disease A. Abnormal Conditions and Nutritional Implications 1. Gastrointestinal disorders a. Ulcer b. Hiatus hernia c. Hypermotility d. Gluten-induced enteropathy e. Constipation f. Diverticulosis and diverticulitis g. Gastroenteritis and colitis h. Lactose intolerance and lactase deficiency i. Surgery j . Malabsorption 2.

Liver, biliary tract, and pancreatic disorders a. Viral hepatitis b. Cirrhosis c. Hepatic coma d. Diseases of the gallbladder e. Pancreatitis f. Cystic fibrosis

3.

Cardiovascular disorders a. Atherosclerosis and arteriosclerosis b. Hypertension c. Congestive heart failure d. Myocardial infarction e. Hyperlipoproteinemias

4.

Renal disorders a. Renal calculi b. Nephritis c. Uremia and renal failure d. Nephrotic syndrome

5.

Endocrine and metabolic disorders a. Diabetes mellitus b. Hypoglycemia

232

Outline of Contents c. Adrenal cortex insufficiency d. Hyper- and hypothyroidism e . Gout f. Inborn errors of metabolism (enzymedeficiency diseases) 6.

Skeletal and connective tissue disorders

7.

Nervous system disorders

8.

Anemias

9.

Allergies

10.

Fevers and infections

11.

Inflicted trauma a. Surgery b. Burns c. Lacerations and fractures

12.

Neoplastic disease

13.

Handicapping conditions and rehabilitation a. Physical deformities b. Hyperkinesis

14.

Protein-calorie malnutrition

15.

Obesity

16.

Disorders of the oral cavity and esophagus

17.

Complications of pregnancy

18.

Alcoholism and other substance abuse

B.

Drug Nutrient Interaction 1. Effect of drugs on nutrient absorption and utilization 2. Effect of foods on drug absorption and utilization

C.

Modifications of the Normal Diet 1. Consistency 2. Frequency and amount

Outline of Contents D.

III.

Patient Management and Counseling 1. Adapting counseling to client’s lifestyle and needs 2. Medical records 3. Nutrition care plans 4. Dietitians on health care teams 5. Evaluation of effectiveness

Nutritional Support of the Critically 111 A. Tube Feedings B.

IV.

233

Parenteral Feedings

Quality Assurance and Peer Review

COMMUNITY NUTRITION

I.

II. III. IV. V.

Assessment and Surveillance of Community Nutrition Needs A. Problem Identification B.

Community Resources

C.

Nutrition and Dietary Surveys

Planning for Community Nutrition Programs Implementation of Nutrition Programs in the Community Evaluation of Community Nutrition Programs Nutrition Education of the Public A. Process Skills and Concepts 1. Teaching/learning 2. Communication B.

VI.

VII.

Consumerism

Legislation and Public Policy on Food and Nutrition Programs A. Programs for the Economically Disadvantaged B. Maternal and Child Nutrition Programs C. Programs for the Elderly International Policies and Programs

Outline of Contents

234

MANAGEMENT

I.

II.

III.

Management Theories and Their Application A. Traditional or Classical B.

Human Relations

C.

Systems Approach

Management Functions A. Planning 1. Establishment of objectives 2. Establishment of policies and procedures 3. Short- and long-term planning (forecasting) B.

Organizing 1. Identification and grouping of tasks 2. Establishment of organizational structure

C.

Staffing 1. Recruiting, interviewing, and hiring 2. Orientation 3. Employee and production schedules 4. Wage and salary administration

D.

Directing or Coordinating 1. Principles of coordination 2. Delegation 3. Communication 4. Motivation 5. Leadership styles and skills 6. Training 7. Work simplification/work improvement

E.

Controlling or Evaluating 1. Establishment of qualitative and quantitative standards 2. Types of control 3. Feedback 4. Reports and operational indicators 5. Performance appraisal and promotion 6. Finance 7. Legislative influences

Safety A. Governmental Standards and Regulations

Outline of Contents B. IV.

V.

235

Safety Policies and Programs

Labor/Management Relations A. Morale and Productivity B.

Grievance Procedures

C.

Personnel Services

D.

Unionization 1. Union rights and responsibilities 2. Employee rights and responsibilities 3. Employer rights and responsibilities 4. Collective Bargaining a. Bargaining strategies b. Mediation c. Arbitration 5. Union Security a. Check-off b. Union shops c. Open shops d. Closed shops e . Agency shops

Legislation A. Unemployment Compensation B.

Workmen’s Compensation

C.

National Labor Relations Act (Wagner)

D.

Taft-Hartley Act

E.

Labor-Management Reporting and Disclosure Act

F.

Fair Labor Standards Act

G.

Civil Rights Act of 1964

H.

Age Discrimination Act of 1967

I.

Manpower Development and Training Act

J.

Equal Employment Opportunity Act

K.

OSHA Act (Occupational Safety and Health Act) 1. Standards 2. Record Keeping

236

Outline of Contents 3. L.

VI.

Inspection

Other

Management Information Systems A. Computer Applications B.

Other Systems

FOOD SERVICE OPERATIONS

I.

Menu Planning A. Considerations in Menu Planning 1. Clientele 2. Types of facility 3. Policies 4. Nutritional adequacy 5. Aesthetic factors 6. Arrangement of kitchen and serving area 7. Equipment 8. Personnel 9. Budget 10. Style of service 11. Food production policies and procedures 12. Market form of food B.

II.

III.

Types of Menus

Purchasing A. Procedures and Policies B.

Tools for Control 1. Written specifications 2. Purchase requisitions

C.

Market Structure and Trends

D.

Legal Requirements and Ethics

Receiving and Storage A. Receiving and Procedures 1. Receiving records 2. Receiving equipment 3. Product inspection control

Outline of Contents B.

IV.

Production Systems 1. Conventional 2. Commissary 3. Ready-prepared (cook-freeze or cook-chill) 4. Assembly-serve

Food Delivery and Service Systems A. Delivery Systems 1. Centralized or decentralized 2. Examples of systems a. Heated and refrigerated carts b. Integral heat system c. Automated cart transport system d. Other B.

VI.

Storage of Food, Equipment, and Supplies 1. Location of facilities 2. Storage and inventory control 3. Issue from storage a. Requisition b. Ingredient room

Production and Processing A. Production Controls 1. Scheduling 2. Standardized recipes 3. Control of food quality 4. Control of food quantity B.

V.

237

Service Systems 1. Self-service 2. Tray service 3. Waiter/Waitress service 4. Portable meals

Layout and Design A. Factors to Consider in Planning 1. Safety and sanitation 2. Menu and type of food service 3. Available energy sources 4. Codes and standards 5. Wall and floor services 6. Ventilation 7. Lighting 8. Insulation 9. Accessibility for the handicapped 10. Efficient materials handling

238

VII.

Outline of Contents B.

Process of Designing 1. Tools and techniques 2. Selection of materials 3. Placement of equipment

C.

The Planning Team

Equipment A. Design and Selection 1. Specifications 2. Conforming to codes 3. Construction features a. Safety b. Ease of cleaning c. Energy requirements d. Mobility e. Durability 4. Selection equipment B.

VIII.

Sanitation A. Sanitation Codes and Practices B.

IX.

Use and Depreciation of Equipment

Equipment Cleaning and Maintenance

Energy A. Measures of Energy B.

Control of Energy Consumption

C.

Estimating Energy Use

D.

Energy Conservation

FOOD SCIENCE

I.

Physical and Chemical Properties of Foods A. Characteristics of Acids, Bases, and Buffers B.

Dispersion Systems in Foods

C.

Heat Transfer in Food

Outline of Contents

II. III.

D.

Browning Reactions

E.

Importance of Enzymes in Food

F.

General Characteristics and Structure of Carbohydrates, Proteins, and Lipids

Characteristics and Evaluation of Food Quality Food Preservation A. Causes of Food Spoilage B.

IV.

V.

VII.

Methods

Consumer Protection Related to Food A. Federal Agencies and Legislation B.

Federal, State, and Local Regulations and Standards including Labeling

C.

Regulation of Special Dietary Foods

D.

Food Additives

Food-borne Illness and Sanitation A. Classification and Characteristics of Food-borne Illness B.

VI.

239

Control of Food-borne Illness

Fruits and Vegetables A. Structure of Plant Tissue B.

Chemical Composition, including Pigments

C.

Nutritive Value

D.

Quality

E.

Storage

F.

Principles of Preparation and Processing

G.

Vegetable Protein Concentrates and Isolates

Meat, Poultry, and Fish A. Structure and Composition

240

VIII.

Outline of Contents B.

Nutritive Value

C.

Selection, Identification, and Characteristics of Meat Cuts

D.

Quality

E.

Storage

F.

Principles of Preparation and Processing

Eggs A. Structure and Composition B.

Nutritive Value

C.

Quality

D.

Principles of Preparation and Processing

E. Egg Substitutes IX.

X.

Milk and Milk Products A. Composition and Nutritive Value B.

Quality of Milk

C.

Use of Milk in Food Preparation

D.

Processing of Milk

E.

Butter and Cream

F.

Cheese

G.

Imitation Milk Products

Grains and Cereals A. Chemical Composition and Structure of Grains B.

Nutritional Value, Enrichment, and Fortification

C.

Preparation and Processing of Cereals and Flours

D.

Composition and Characteristics of Wheat Flours

E.

Alimentary Pastes

Outline of Contents XI.

XII.

XIII.

XIV.

241

Baked Flour Mixtures A. Functional Properties of Ingredients B.

Proportions of Ingredients

C.

Methods of Mixing

D.

Convenience Forms

E.

Leavening Agents

F.

Quick Breads

G.

Cakes

H.

Cookies

I.

Pastry

J.

Yeast Doughs

K.

Baking at High Altitudes

Starch A.

Characteristics and Structure

B.

Processing and Modification

C.

Uses in Food Preparation

Crystallization in Food Preparation A.

Factors Affecting Growth and Formation of Crystals

B.

Candies and Sugars

C.

Frozen Desserts

Gelatin A.

Properties and Uses

B.

Nutritive Value

C.

Conversion of Collagen to Gelatin

242

Outline of Contents

XV.

XVI.

D.

Gel Formation

E.

Convenience Forms

Fats A.

Types Used in Food Preparation

B.

Processing

C.

Oxidation and Other Deteriorative Changes

D.

Frying

E.

Emulsions

Other

COMPUTER-BASED NUTRITION EDUCATION

I. II. III. IV. V. VI. VII. VIII. IX. X. XI.

Normal Nutrition Clinical Nutrition Community Nutrition Management Food Service Operations Food Science General Public Elementary and Secondary Education Higher Education Professional Test-Item Banks