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Background: Guidelines recommend enteral feeding via gastrostomy should be considered for adult survivors of stroke with dysphagia who cannot eat or drink sufficiently for >4 weeks. Many people continue long‐term tube‐feeding via this route in the community where healthcare professionals contribute to their care and nutritional management, although little is known about their experiences of or attitudes towards enteral feeding in this situation. The present study aimed to explore the experiences and attitudes of healthcare professionals working with this patient group. Methods: Healthcare professionals were invited to complete a questionnaire devised for the study which comprised closed and open questions about tube‐feeding including their patients' participation in feeding processes and mealtimes and how these might be improved. Responses to closed questions were analysed descriptively and free‐text responses analysed using thematic analysis. Results: Fifty‐seven participants met the inclusion criteria. They identified patients' quality of life (77% of respondents) and nutritional support (75%) as the most important aspects of tube‐feeding. Good communication and training with healthcare teams and carers were considered important. Their patients' participation in tube‐feed administration and mealtime involvement were described as variable and potentially beneficial, but both were related to patients' choice and health impairment. Blended tube‐feeding was considered an option by 89% provided practical and safety conditions were met. Conclusions: Participants' experiences of and attitudes towards tube feeding in adults living with stroke in the community in the sample in the present study are varied and focussed on individual patients' needs, safety and professional standards. Highlights: Quality of life and nutritional support are considered the most important aspects of tube‐feeding in adults living in the community following stroke.Patient choice should be considered in all aspects of decision‐making about tube‐feeding.Good communication and training are considered important for successful tube‐feeding in the community.Patients' participation in administering their own feed or involvement in mealtimes is variable and related to their choice and health impairment.Blended feeding is considered an option providing practical and safety consideration are addressed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the nutrient quality of breads and breakfast cereals identified using the wholegrain definition of ≤10:1 carbohydrate:fibre ratio.Design: Following a cross-sectional study design, nutritional information was systematically gathered from food labels of breads and breakfast cereals that met the ≤10:1 carbohydrate:fibre criterion. The median nutrient content was compared with the UK Food Standards Agency's nutrient profiling standards and the associations between carbohydrate:fibre ratio and other nutrients were analysed. Subgroup analyses were undertaken for products with and without fruit, nuts and/or seeds.Setting: Products from four major supermarket stores in the UK.Subjects: Breads (n 162) and breakfast cereals (n 266).Results: Breads which met the ≤10:1 criterion typically contained medium fat, low saturated fat, low sugar and medium Na. Breakfast cereals typically contained medium fat, low saturated fat, high sugar and low Na. In both groups, as the carbohydrate:fibre ratio decreased, fat content increased (bread: P=0·029, r=-0·171; breakfast cereal: P=0·033, r=-0·131) and, in breakfast cereals, as the ratio increased, sugar content increased (P<0·0005, r=0·381). Breakfast cereals with fruit, nuts and/or seeds contained, per 100 g, more energy (P=0·002), fat, saturated fat and sugar (all P<0·0005), while seeded breads had more energy, fat and saturated fat (all P<0·0005).Conclusions: Overall, breads and breakfast cereals meeting the ≤10:1 criterion have good nutritional quality, suggesting that the criterion could be useful in public health and/or food labelling. The utility of applying the ≤10:1 criterion to products containing fruit, nuts and/or seeds is less clear and requires further research. [ABSTRACT FROM AUTHOR]

The article focuses on the need for sustainability in dietetics, addressing the challenge of finding dietetics-relevant research for more sustainable food systems and dietary patterns. Topics discussed include the role of nutritionists and dietitians in influencing institutions and individuals, the diversity in defining sustainable food systems and diets, and the importance of regionally specific research and contributions from diverse practice areas.

Background Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients' needs are associated with better health outcomes but no studies investigating patients' preferences for nutrition-related outcomes in liver disease have been published. The present study aimed to identify nutrition-related health outcomes that are important to patients with liver disease. Methods An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised a Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results Fifty-one patients participated (22 men and 29 women). Responses indicated a wide range of preferred nutrition-related outcomes, with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, as well as on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than did men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included an increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions The present study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management. [ABSTRACT FROM AUTHOR]

Reports the validation of a computer based system for assessing dietary intake. Use of a dietary history method and a computer based system in assessing dietary intake; Comparison on the results with food tables assessment; Advantages of computer based system in assessing dietary intake.

Background: The home medicines review (HMR) program aims to achieve quality use of medicines. In 2009, the model of HMR provision at Danila Dilba Health Service (DDHS) in Darwin was adjusted to include the services of a dedicated consultant pharmacist and an expanded role for an Aboriginal Health Worker (AHW) in the HMR process. Aim: This study evaluated a unique program providing HMRs to Indigenous clients of DDHS. Methods: A retrospective review of HMRs was conducted for clients at DDHS between December 2009 and December 2010 to determine relevant time frames between HMR activities, reasons for referral, issues identified by the pharmacist, education provided, recommendations and uptake of recommendations. Awareness and attitudes to the program among general practitioners (GPs), AHWs, and pharmacists were also evaluated using a self‐administered questionnaire. Results: Sixty‐four HMRs were conducted. Thirty‐nine (61%) follow‐up appointments were documented and 30 Medicare claims made. The average time between referral and follow‐up was 66 days. For most HMRs, more than one reason for referral was identified. In all, 348 issues were identified, 256 educational activities undertaken and 379 recommendations made. Fifty‐two per cent of recommendations were implemented. Attitudes to the HMR program were positive. Common themes included the importance of cultural safety, particularly the inclusion of an AHW in HMR activities and difficulties associated with the follow‐up of patients. Conclusion: Uptake of recommendations for improvements in the quality of documentation, GP follow‐up and the referral system will enhance the HMR service at DDHS. [ABSTRACT FROM AUTHOR]

Discusses the steps for dietitian to use their research skills to maintain their qualification. Importance of continuous training; Role of dietitians to provide optimum nutritional care.

The article reviews the book "Cholesterol and Beyond: The Research of Diet and Coronary Heart Disease 1900-2000," by A. S. Truswell.

Background: Research is a cornerstone of evidence‐based dietetic practice. Research skills are often taught at university through experiential learning during a final‐year research project. The present study aimed to investigate attitudes towards research and confidence in research skills among student dietitians before and after a research project. Methods: A questionnaire survey of student dietitians' attitudes to research and confidence in research skills was undertaken before and after completing a research project at two universities in London, UK. Dichotomous data were compared before and after the research project using a McNemar's test. Factors associated with 'high confidence' or 'improved confidence' in overall research skills at the end of the research project were investigated using multivariable logistic regression. Results: In total, 160 student dietitians completed a questionnaire before and after their research project. The majority had positive attitudes to research both before and after their research project. There was an increase in numbers with 'high confidence' in overall research skills before (13; 8.1%) and after (79; 49.4%) the research project (p < 0.001), and 113 (70.6%) reported 'improved confidence' in overall research skills. The only factor associated with 'high confidence' in overall research skills was having 'high levels of involvement in the overall research process' (odds ratio = 6.13, 95% confidence interval = 2.03–18.49, p = 0.001). Conclusions: Student dietitians have positive attitudes towards research and undertaking a research project significantly improves confidence in their research skills. A higher level of involvement in the research project is the single most significant factor associated with high confidence in research skills. Key points: This is the largest study to date of student dietitians' experiences of undertaking a research project during their university degree.Student dietitians have positive attitudes to research both before and after their research project.Research projects improve student dietitians' confidence in their research skills.The single most significant factor associated with developing high confidence in research skills is having a greater level of involvement in the project. [ABSTRACT FROM AUTHOR]

Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population. Individual mREE data were available for 900 patients with cirrhosis (mean [±1 SD] age 55.7±11.6 years-old; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 years-old; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean ± 1 SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build 3 new prediction models which included sex, ethnicity, body composition measures, and model for end-stage liver disease scores. The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.4±3.8 cf. 20.8±2.6 kcal/kg/24 hr; p <0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24 hr; p < 0.001). Overall, 37.1% of Caucasian and 25.3% of Asian patients were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24 hr less to 548 kcal/24 hr more than the mREE. Newly derived prediction equations provided better estimates of mREE but still had limited clinical utility. Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured. People with cirrhosis are often malnourished and this has a detrimental effect on outcome. Provision of an adequate diet is very important and is best achieved by measuring daily energy requirements and adjusting dietary intake accordingly. Prediction equations, which use information on age, sex, weight, and height can be used to estimate energy requirements; however, the results they provide are not accurate enough for clinical use, particularly as they vary according to sex and ethnicity. [Display omitted] • Malnutrition has a significant negative effect on outcome in patients with cirrhosis. • Accurate information on daily energy requirements is essential for effective nutritional management. • Prediction equations provide estimates of daily energy expenditure, but these vary significantly by ethnicity. • Where available, resting energy expenditure should be measured using indirect calorimetry. [ABSTRACT FROM AUTHOR]

ObjectiveThe predominance of marketing of products high in fat, sugar and/or salt to children has been well documented and implicated in the incidence of obesity. The present study aimed to determine whether foods marketed to children in UK supermarkets are nutritionally similar to the non-children's equivalent, focusing on food categories that may be viewed as healthier options.DesignNutritional data were collected on yoghurts (n 147), cereal bars (n 145) and ready meals (n 144) from seven major UK supermarkets and categorised as children's or non-children's products based on the characteristics, promotional nature or information on the product packaging. Fat, sugar and salt content was compared per 100 g and per recommended portion size.SettingUK.ResultsPer 100 g, children's yoghurts and cereal bars were higher in total sugars, fat and saturated fat than the non-children's; this was significant for all except sugar and total fat in cereal bars. Per portion these differences remained, except for sugars in yoghurts. Conversely children's ready meals were significantly lower in these nutrients per portion than non-children's, but not when expressed per 100 g. Children's yoghurts and ready meals had significantly lower sodium content than non-children's both per portion and per 100 g.ConclusionsSignificant differences between the nutritional composition of children's and non-children's products were observed but varied depending on the unit reference. A significant number of products marketed towards children were higher in fat, sugar and salt than those marketed to the general population. [ABSTRACT FROM AUTHOR]

Abstract: Two universities in the United Kingdom made systematic attempts to increase the number of student dietitians’ research projects that are supervised by university faculty members in conjunction with external collaborators (collaborative projects), rather than by faculty alone (faculty-only projects). A questionnaire survey was used to evaluate the experiences of student dietitians (n=110), university faculty members (n=38), and collaborators (n=31) involved in a student research project, comparing those involved in a faculty-only project with those involved in a collaborative project. Students undertaking collaborative projects reported greater involvement in most areas of the research process and greater skill development in obtaining research ethics approval (P=0.005), data collection (P=0.05), and statistical analysis (P=0.004) than students undertaking faculty-only projects. In addition, collaborative projects were more frequently considered to produce results that would change dietetics practice than faculty-only projects by both student dietitians (60% vs 30%, P=0.01) and university faculty members (62% vs 19%, P<0.001). The collaborators also considered that in the majority of instances (61%) their involvement helped them to organize their own time to do research. The type of project did not appear to influence student’s expectations of future involvement in research and audit. In general, both types of projects resulted in positive experiences for student dietitians, university faculty members, and collaborators. We recommend that those involved in dietetics education, practice, and management consider the potential value of senior-level student dietitian involvement in collaborative research projects. [Copyright &y& Elsevier]

Background: Liver transplant recipients are given diet and physical activity advice to aid recovery and promote long‐term health. The present study aimed to explore patients' experiences of receiving and implementing diet and physical activity advice after liver transplant and identify barriers and facilitators to following recommendations. Methods: A qualitative descriptive design included purposive sampling of 13 liver transplant recipients. Semi‐structured audio‐recorded interviews and inductive thematic analysis using a framework were undertaken concurrently to enable recruitment until saturation of themes occurred. Results: Overall experiences varied between participants and settings, as well as over time. Seven themes emerged, all representing both barriers and facilitators to implementing advice. Poor capability and loss of confidence were barriers that improved in hospital because healthcare professionals enabled participants to set and achieve goals but remained key barriers after discharge from hospital. The format and consistency of advice influenced participants' confidence in the healthcare team. Social support helped participants to return to and implement advice, although social networks could also have a negative influence. Advice and modelling of behaviour from other transplant recipients were facilitators. Symptoms, side effects, comorbidities and the environment presented barriers and facilitators. The desire to return to normal and coping strategies were drivers of behaviours, which were also influenced by participants' beliefs and values. Conclusions: The variation in experiences indicates a need for individually tailored advice that is consistent across the multidisciplinary team. Interventions for behaviour change that merit further investigation include goal setting, improving coping strategies, peer support and modifying the hospital and home environment. [ABSTRACT FROM AUTHOR]

This study examines the impact of the Learning Strategies Curriculum (LSC), an adolescent reading intervention program, on 6th- and 9th-grade students' reading comprehension and strategy use. Using a randomized treatment- control group design, the study compared student outcomes for these constructs for 365 students who received daily instruction in 6 LSC strategies and 290 students who did not receive intervention instruction. After 1 school year, 6th-grade students who received intervention instruction significantly outperformed students in the control group on a standardized measure of reading comprehension and reported using problem-solving strategies in reading to a greater extent than students in the control group. There were no significant differences between 9th grade intervention and control groups in reading comprehension or strategy use. [ABSTRACT FROM AUTHOR]