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Summary: Background: Clinical practice recommendations for macronutrient intake in Metabolic and Bariatric Surgery (MBS) are insufficiently grounded in the research, possibly due to a paucity of research in key areas necessary to support macronutrient recommendations. An initial scoping review, prior to any systematic review, was determined to be vital. Objectives: To identify topical areas in macronutrients and MBS with a sufficient evidence base to guide nutrition recommendations. Methods: PubMed, Cochrane, Ovid Medline, and Embase were initially searched in January 2019 (updated November 1, 2023) with terms encompassing current bariatric surgeries and macronutrients. Out of 757 records identified, 98 were included. A template was created. Five types of outcomes were identified for extraction: dietary intake, anthropometrics, adverse symptoms, health, and metabolic outcomes. All stages of screening and extraction were conducted independently by at least two authors and disagreements were resolved via team discussion. Macronutrient‐related dietary treatments were classified as either innovative or standard of care. Descriptions of dietary arms were extracted in detail for a qualitatively generated typology of dietary or nutritional treatments. Heatmaps (treatments by outcomes) were produced to identify promising topics for further systematic analyses. Results: We identified protein supplementation and "food‐focused" (e.g., portion‐controlled meals, particular foods in the diet, etc.) topical areas in MBS nutrition care with potentially sufficient evidence to create specific MBS Macronutrients guidelines and identified topical areas with little research. Conclusions: Clinical practice regarding macronutrient intake remains guided by consensus and indirect evidence. We detail ways that leadership at the profession level may remedy this. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university‐level nutrition education provided to dental and oral health students globally.A scoping review identified relevant literature through search terms “dentistry,” “oral health,” or “oral hygiene”; “dental students” or “dental education”; “nutrition education” or “nutrition science.” Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied.A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education.Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised. [ABSTRACT FROM AUTHOR]

Background: Due to the significant increase in the prevalence of food-related diseases, the value that physicians place on nutritional advice may have implications for patient treatment. The objective of this study was to evaluate the perception of the importance of nutritional intervention among physicians in the Universidad San Francisco de Quito's (USFQ) healthcare system. Methods: This cross-sectional study employed a telephone survey administered to a subset of all medical doctors (MDs) working in the healthcare system clinics of USFQ between 2021 and 2022. Study participants were recruited through voluntary response sample from a complete list of 253 MD. The single time questionnaire consisted of a 22-item validated survey in which attitudes, self-perceived capacity, and knowledge about nutrition ofmedical doctors were evaluated. Data was analyzed using descriptive statistics, two-sided t test, bivariate associations and linear and logistic regressions. Results: 136 MDs completed the survey yielding a response rate of 54%. Our analysis grouped participants into clinical (CE) and non-clinical specialties, hereafter referred to as surgical MDs. While a higher percentage of physicians in CE are confident in their ability to provide examples of recommended food portions based on national or international guidelines, 1 in 10 do not know how to use and interpret BMI or waist circumference, and around 1 in 3 do not know how many calories there are in one gram of fat, protein, or carbohydrates, and their basic metabolic functions. Almost all survey participants believe MDs can have an impact on the eating behavior of a patient if time is used to discuss the problem, however, almost half of survey participants believe nutrition counseling is not an effective use of time. Conclusion: It is important to explore the perceptions and self-confidence of physicians around nutrition related issues. Our results demonstrated that nearly 1 in 4 surgical MDs do not feel capable of recognizing nutritional risk in patients, which highlights the essentiality of physicians having an updated understanding of basic nutrition principles. Future research should examine how commonly MDs refer patients to nutritionists/dietitians, as well as strategies for improving physician knowledge on basic nutrition concepts. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus is a non-communicable disease with a high prevalence in Indonesia, as reported by Riskesdas 2018. Uncontrolled glucose levels can cause microvascular damage such as retinopathy, nephropathy and neuropathy, as well as increasing the risk of cardiovascular disease, stroke and decreased quality of life. Management of diabetes mellitus consists of four main pillars: education, diet, physical exercise/physical activity, and medication. In terms of diet, management is carried out using the 3J principle (Type, Amount, Schedule) to ensure food intake meets the patient's needs and prevent complications. Three diabetes mellitus patients with stroke complications experienced nutritional problems, namely insufficient oral food intake and lack of knowledge during hospitalization with a diagnosis of type 2 DM and stroke. To overcome this problem, a low carbohydrate, low fat and low salt diet is given with variations in the type and form of food according to the patient's abilities. Collaboration with the doctor in charge and education to the patient's family is important to increase their understanding and motivation in maintaining health after hospitalization. The results of this intervention showed significant improvements in the nutritional problems of diabetes mellitus patients with complications of stroke and hypertension. INSET: c. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal cancer (CRC) is among the three most commonly diagnosed cancers globally, after breast and lung cancer, with an estimated 2 million new cases each year, comprising ten per cent of all cancers worldwide. CRC has a complex aetiology associated with several nutrition-related risk factors. Cancer survivors frequently report alterations to their dietary habits and nutritional intake, with related adverse impacts on health-related quality of life (QOL). Whilst nutrition-related factors are recognised as survivor priorities and embedded in survivor care policies, dietary support is frequently not the standard of care in practice. Methods and results: In this Commentary, we present details of a critical policy-practice gap for CRC survivors across the spectrum of nutrition care that we have seen growing in the literature, in hospitals, community and private practice. Conclusion: As these nutrition concerns can adversely impact QOL and morbidity and mortality risks, we hope to raise awareness of these issues to provide a basis of future work in this area, so that policymakers and clinicians can improve support and outcomes for CRC survivors and their families. [ABSTRACT FROM AUTHOR]

We have examined the influence of early postoperative nutritional nursing on the prognosis of patients undergoing gastrointestinal surgery. A total of 82 patients with gastrointestinal surgery were recruited from the First Affiliated Hospital of Soochow University between January 2020 and December 2022 for this study. The patients were divided into two equalsized control and treatment groups. The control group received routine care, whereas the treatment group received added nutritional care. Compared to the control group, the first exhaust time, first defecation time, and hospitalization time in the treatment group were shorter (P < 0.01). On the 7th day after surgery, no difference was found in the levels of albumin and total protein between the two groups (P > 0.05). However, on the 4th and 7th days after surgery, the diamine oxidase and malondialdehyde values in the treatment group were lower relative to the control group. Body weight in the treatment group was higher, the incidence of complications was lower, and the quality-of-life score and immune function were better compared to the control group (P < 0.05). To sum up, early nutritional care is beneficial to improving the immune function indexes, nutritional indexes, and quality of life of patients after gastrointestinal surgery, as well as reducing the occurrence of postoperative adverse reactions. [ABSTRACT FROM AUTHOR]

This commentary represents a dialogue on key aspects of disease-related malnutrition (DRM) from leaders and experts from academia, health across disciplines, and several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcomes, nutrition care as a human right, and practice, implementation, and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society and the Canadian Malnutrition Task Force in the UN/WHO Decade of Action on Nutrition to advance policy-based approaches for DRM. This commitment was successfully registered in October 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease-Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad. [ABSTRACT FROM AUTHOR]

Aims: The nutrition and dietetics service in Philippine public hospitals was implemented by the Department of Health in 2016 to standardise the daily allowance and nutritional content of inpatient meals. Five years later, it is timely for the Department of Health to assess the quality of inpatient meals and mandated nutrition processes in areas such as staffing, food service, and outcomes monitoring. Methods: A mixed‐method sequential explanatory design was employed using (1) quantitative assessment through a facility survey (n = 193 hospitals) and (2) qualitative exploration of quantitative results through 6 focus group discussions (n = 36 hospitals). Results: Philippine public hospitals were unequipped with the inputs necessary to implement processes that produce high‐quality meals for patients. The hospitals were unable to comply with the required minimum meal allowance (51%), nutritional content of meals (40%), and food service standards. Moreover, they had insufficient human resources and inefficient food procurement practices. Conclusions: The quality of nutrition care and inpatient meals in Philippine public hospitals, who serve mostly people on low incomes, is a neglected problem in the Philippines. Moving forward, a systems approach involving the Department of Health, its regional offices, and hospital management is necessary to equip Philippine public hospitals with the inputs and structures necessary to provide high‐quality nutrition care and inpatient meals that will facilitate patient recovery and overall patient health. [ABSTRACT FROM AUTHOR]

Background: Dietitians are healthcare professionals with potential roles and impacts in primary care (PC) settings when applying knowledge and expertise to educate healthcare clients at all levels and treat chronic diseases. This study seeks to compare and evaluate the nutrition care services and practices in obesity management in primary care centres for two periods (2016 and 2019) in Jeddah city, Saudi Arabia. Methods: Surveys with service self-reporting evaluation used responses from 18 and 27 centres in 2016 and 2019. Services evaluation used no reference to a standard, but 18 of the surveyed PC centres in 2019 were previously visited in 2016 to assess the provided nutrition care services for adult obesity in PC centres. The re-visit survey investigated improvements in services achieved in 2019 concerning services for adults with obesity. A chi-square test was used to compare the surveys' results in the two periods, which resulted in a significant difference in the provided nutrition care services for adult obesity between 2016 and 2019. Results: Dietitians' employment has significantly changed (P <.0001) in 2019 compared to 2016. Dietitians were significantly noticed as the primary source of nutrition information after their integration into the services (P <.0001) in 2019. Services provided for adult obesity increased significantly (P value <.0001) in the second phase. However, there was no significant difference in serving adult groups between the two periods (P =.056). Conclusions: Integrating dietitians into the PC services significantly enhanced their role in supporting PC services for conditions relating to adult obesity, which allowed them to be the most important source of the delivered nutrition information to patients. The employment rate of PC dietitians accredited by the governing body is significantly increasing; the Saudi Commission for Health Specialties will need to monitor it to ensure that dietitians have the qualifications and skills to provide professional medical nutrition therapy to patients. Further research to evaluate the quality of PC dietetic practice and improvements in patient outcomes is required to strengthen the importance of integrating registered dietitians into the services. [ABSTRACT FROM AUTHOR]

Background: Poor diet is implicated in multiple chronic diseases. Although doctors may be well placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors. Method: Semi‐structured interviews were conducted with primary care doctors/general practitioners (n = 14) and medical specialists (n = 8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. Results: Framework analysis identified five key themes: (1) knowledge and skills in nutrition to support medical nutrition care, (2) the delivery of nutrition education, (3) multidisciplinary and interdisciplinary care, (4) systemic barriers and facilitators to care and (5) the need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill‐equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. Conclusion: Participants highlighted a lack of knowledge and training regarding nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift from the medical model. Key points: This qualitative study explores work roles, attitudes, barriers and enablers in the delivery of nutrition care among a cohort of Australian and UK doctors.Doctors acknowledge nutrition as an important component of nutrition care but are ill‐equipped to support such care, identifying limitations to the systems that might support integrated care.Efforts to build the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition – a paradigm shift away from a traditional medical (treatment) model. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that malnutrition can affect both recovery and outcome in acute care patients, little is known about malnutrition in Palestine, and even less is known about the assessment of malnutrition knowledge, attitudes, and practices (M-KAP) toward healthcare providers and nutrition care quality measures in hospitalized patients. Therefore, this study aimed to evaluate the M-KAP of physicians and nurses in routine clinical care and determine the influencing factors. Methods: From April 1 to June 31, 2019, cross-sectional research was performed at governmental (n = 5) and non-governmental (n = 4) hospitals in the North West Bank of Palestine. Data were collected using a structured self-administered questionnaire from physicians and nurses to collect information on knowledge, attitude, and practices related to malnutrition and nutrition care, alongside sociodemographic characteristics. Results: A total of 405 physicians and nurses were participated in the study. Only 56% of participants strongly agreed that nutrition was important, only 27% strongly agreed that there should be nutrition screening, only 25% felt food helped with recovery, and around 12% felt nutrition as part of their job. Approximately 70% of participants said they should refer to a dietitian, but only 23% knew how and only 13% knew when. The median knowledge/attitude score was 71, with an IQR ranging from 65.00 to 75.00, and the median practice score was 15.00 with an IQR of 13.00–18.00. The mean knowledge attitude practice score was 85.62 out of 128 with SD (9.50). Respondents who worked in non-governmental hospitals showed higher practice scores (p < 0.05), while staff nurses and ICU workers showed the highest practice score (p < 0.001). Respondents with younger age categories, working in non-governmental hospitals in the ICU as practical and staff nurses, showed the highest KAP score (p < 0.05). Significance positive correlations were found between respondents' knowledge/attitude and practice scores regarding the quality of nutrition care in hospitals (r = 0.384, p value < 0.05). In addition, the result also revealed that almost half of respondents believed that the most important barriers to inadequate intake of food at the bedside are related to food appearance, taste, and aroma of meals served (58.0%). Conclusions: The research revealed that inadequate knowledge was perceived as a barrier to effective nutrition care to the patient. Many beliefs and attitudes do not always translate into practice. Although the M-KAP of physicians and nurses is lower than in some other countries/studies, it highlights a strong need for more nutrition professionals in the hospital and increasing nutrition education to improve nutrition care in hospitals in Palestine. Furthermore, establishing a nutrition task force in hospitals elaborated by dietitians as the unique nutrition care provider will assure to implementation of a standardized nutrition care process. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to describe the quantity and cost of in‐person and telehealth dietetics services reimbursed under Australia's Medicare Benefits Scheme, before and during the coronavirus pandemic. Methods: Publicly available Medicare Benefits Scheme dietetics service activity data were extracted from an online database, between January 2019 and June 2021. For allied health telehealth items, it was assumed that between 10% and 20% of all consults were dietetic related. Results: Dietetics service claims reimbursed through the Medicare Benefits Scheme averaged 115 thousand per quarter in 2019. In quarter 2 of 2020, service delivery dropped by 25% compared to quarter 1 of 2020 and 32% compared to 2019. This drop recovered in quarters 3 and 4, with dietetic consultations claimed through the Medicare Benefits Scheme remaining relatively comparable to 2019 data. Dietetics services cost AUD 5,868,021 in quarter 1 2019 and AUD 5,742,632 in quarter 1 2020. Since the introduction of allied health telehealth items, the number of consultations claimed per quarter has accounted for between 17.7% (quarter 2 2020) and 4.5% (quarter 2 2021) of all consultations per quarter. Conclusions: The provision and costs of dietetics services in Australia have remained relatively constant compared to 2019 data, indicating telehealth was being used for substitutive rather than additive care, apart from an initial reduction of 25% between March and June 2020. The introduction of telehealth items for dietitians has been modest, peaking at 17.7% and now consistently averaging 5% of total dietetics services. The permanent implementation of telehealth items is unlikely to cause significant increases in cost or access and will assist Australians to eat better to support improved chronic disease outcomes. [ABSTRACT FROM AUTHOR]

Background: Accurate dietary intake data are critical to nutrition care planning. Commonly used food record charts (FRC) are paper‐based, time consuming, require nutrient analysis estimations, and may provide limited accuracy. The present study aimed to validate Mobile Intake® (MI) (an electronic food intake tool incorporating the five‐point visual scale and providing automatic nutrient analysis) for usability and efficacy in quantifying dietary intake in the healthcare setting. Methods: Two research stages within two tertiary hospitals included: (1) examining criterion validity and efficiency of dietary intake quantification using FRC and MI compared to the gold standard weighed food record (WFR) in a controlled environment and (2) comparing efficiency and effectiveness of FRC and MI in usual care conditions. Results: In Stage 1, dietary intake was calculated (n = 90) with a significant difference across all methods (FRC, MI and WFR) for energy (p = 0.04), but not between MI and WFR (p = 1.00). The time taken for MI (40 s) was significantly less than FRC (174 s) and WFR (371 s) (p < 001). In Stage 2, dietary intake was determined (n = 210) using FRC and MI. Sufficient data to complete dietary analysis were available for 35% of meals from FRC compared to 98% from MI. Calculated mean daily energy intake (4764 ± 1432 kJ vs. 6636 ± 2519 kJ, p = 0.002) and mean daily protein intake (62.9 ± 12.7 g vs. 78.5 ± 22.2 g, p = 0.007) were significantly lower with FRC compared to MI. Average time to complete MI was 14.4 seconds. Conclusions: MI demonstrates efficacy as an accurate measure of dietary intake compared to WFR, as well as usability, providing faster, more accurate and comprehensive real‐time intake data in practice than FRC. Key points: −Identifying and analysing individual dietary intake in the healthcare setting is a critical component of nutrition care.−An electronic food intake tool (Mobile Intake®) was validated for its usability and efficacy in the healthcare setting.−Mobile Intake® provided faster, more accurate and comprehensive real‐time intake data compared to the commonly used manual food record charts, providing an opportunity to improve nutrition care. [ABSTRACT FROM AUTHOR]

Background: Quality improvement strategies have been widely applied in health care; however, little is known about their use in primary care dietetics. This review aims to describe and evaluate the effectiveness of quality improvement strategies that seek to improve patient outcomes by enhancing dietetic care compared to standard dietetic care. Methods: The study employed a systematic review and meta‐analysis design following PRISMA guidelines and included studies up to March 2021. Studies were included if they used a randomised controlled trial (RCT) design to evaluate the effect of a quality improvement strategy applied to care delivered by a dietitian on patient outcomes. A meta‐analysis was conducted where there were sufficient studies with homogeneous populations and outcome measures. Results: Twelve RCTs (n = 1604) met the inclusion criteria for review and five studies (n = 511) were eligible for meta‐analysis for glycated haemoglobin in patients with type 2 diabetes. The most frequently reported quality improvement strategies addressed disease management programs (58%), patient education (67%), group care (42%) and patient self‐management (42%). A positive intervention effect was reported in 50% of the included studies. A low grade of evidence supported a positive intervention effect for quality improvement intervention by a dietitian for glycated haemoglobin (pooled mean difference = −0.39% with 95% confidence interval = −0.70 to −0.08, p = 0.01) in n = 511 patients with type 2 diabetes mellitus. Conclusions: Interventions aimed at enhancing quality in primary care dietetic practice support improvements in patient outcomes. Further research on quality improvement interventions for patient outcomes is required to strengthen the evidence base in this important topic. Keypoints: This systematic review and meta‐analysis synthesises results from 12 randomised controlled trials (RCTs) to evaluate the effectiveness of quality improvement strategies with respect to improving patient outcomes.Quality improvement interventions most frequently aimed to improve effectiveness, efficiency and person‐centredness, whereas no interventions aimed to improve the timeliness or safety of care.Quality improvement interventions employed between one and five strategies, although the number of strategies had no relationship to the intervention effect on the primary outcome measure.The most frequently reported quality improvement strategies were patient education, disease management program, patient self‐management and group care.The meta‐analysis of five RCTs supported a positive intervention effect of a 0.39% improvement in glycated haemoglobin for quality improvement interventions targeting patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Focused antenatal care currently implemented in Tanzania recommends that women receive nutrition care during routine clinic visits. However, little detail is documented in regard to the nutrition information provided to pregnant women during these visits. The present study aimed to investigate whether pregnant women recalled nutrition information or support provided and, if so, who provided this during routine antenatal clinic visits. The secondary aim was to determine how pregnant women intended to implement the information and what mode of delivery was preferred for receiving nutrition information. Methods: An exploratory cross‐sectional study comprising exit interviews was conducted with 50 pregnant women attending antenatal clinics in three regional referral hospitals in Dar es Salaam, Tanzania. Results: All participants (n = 50) reported receiving nutrition care from healthcare workers in regard to; haemoglobin checks (79% of participants), iron and folic acid supplementation (70%), weight measurement (70%), eating advice (60%), and dietary intake assessment (38%). However, the information recalled on each category was inconsistent. For 60% of participants, nurses were reported as the source of nutrition care during pregnancy, followed by medical doctors (22%). The most preferable mode for receiving nutrition information was reported as individual face‐to‐face sessions with health practitioners, followed by mobile phone. All of the participants who received nutrition information indicated that they intended to implement. Conclusions: Nurses were the main source of nutrition information for pregnant women attending antenatal clinics, followed by medical doctors. However, the content of nutrition information recalled by participants was inconsistent. Healthcare facilities need to implement strategies to ensure pregnant women understand and can implement nutrition information provided by healthcare workers during routine antenatal care. [ABSTRACT FROM AUTHOR]

Nutrition care plays a critical role in optimising outcomes for patients receiving treatment for head and neck cancer (HNC), with carers playing an important role in supporting patients to maintain nutrition intake. This study explores patient and carer experience of nutrition care from diagnosis of HNC to 1 year post treatment completion to identify areas for improvement of service delivery. A longitudinal qualitative study design was used with a heterogeneous sample of 20 patients and 15 carers of patients undergoing curative intent treatment for HNC. Interviews conducted at four time points provided a total of 117 interview datasets that were analysed using reflexive thematic analysis based on Gadamerian hermeneutic inquiry. Patient and carer experiences were reflected in two primary themes: (1) the battle to maintain control and (2) navigating the road ahead. This research identifies the need to co-design strategies to improve nutrition care that is inclusive of patients and carers. [ABSTRACT FROM AUTHOR]

Purpose: Radiotherapy for gynaecological cancers often causes gastrointestinal (GI) toxicities such as diarrhoea. Evidence for the potential benefits of dietary interventions on the management of acute GI toxicities is inconclusive and of low quality, with no clear evidence-based guidelines to inform clinical practice. This study aims to provide an overview of current opinions and clinical practice of dietitians treating this cohort and to examine existing models of nutrition care in Australian cancer centres. Methods: Semi-structured interviews were conducted over a video conferencing service to collect information relating to: demographic characteristics; referral protocol and post-treatment pathways; management strategies and interventions prescribed; and attitudes and confidence in service provided. Descriptive analysis was performed on quantitative data, and thematic analysis was performed on qualitative data. Results: In total, 17 dietitians across Australia participated in the study. Almost all centres (94%) had dietetics services available for this patient cohort; however, most did not have an automatic referral pathway (94%) or post-treatment pathway (88%). The opinions and prescription of dietary interventions for symptom management had multiple variations of a 'low' or 'modified-fibre' diet with differing ratios of soluble and insoluble fibre. Over half of the respondents believed that practice was not standardized within their workplace (58%) or Australia (82%). Conclusion: There are variations in service provision with respect to opinions and prescription of dietary modifications within dietetic practice across Australia. The present study highlights the need to investigate the efficacy of dietary interventions on symptom management to better inform evidence-based models of care. [ABSTRACT FROM AUTHOR]

Background: Dietitians are recognised as experts in nutrition care and essential members of multidisciplinary healthcare teams. However, the role of dietitians in caring for people with eating disorders is not well understood. The present review aimed to identify, critically appraise and synthesise the current evidence exploring the views and experiences of dietitians, other health professionals, patients and carers regarding the role of dietitians in the treatment of eating disorders. Methods: CINAHL, MEDLINE, Embase, Scopus and PsycINFO were searched in April 2020 and again in February 2021. Studies were included if they were original research; explored views and experiences of the role of dietitians in the treatment of eating disorders, including perceptions of patients, carers and other health professionals regarding nutrition care for eating disorders; and the full‐text article was available in English. Title and abstract screening, full‐text screening, quality assessment and data extraction were completed in duplicate. Quality assessment was conducted using the Mixed Methods Assessment Tool. Thematic synthesis was used for data analysis. Results: Fourteen studies met the inclusion criteria. Quantitative, qualitative and mixed‐methods study designs were included. Four themes emerged inductively from the data: (i) dietitians as collaborators, educators and counsellors; (ii) dietitians individualising care and desiring a holistic approach; (iii) opportunities for dietitians to gain confidence; and (iv) experiencing nutrition care as a patient or carer. Conclusions: This review suggests that dietitians have a varied role in eating disorder treatment but desire further training. Understanding the training needs of dietitians can identify practice gaps and opportunities to enhance clinician confidence. [ABSTRACT FROM AUTHOR]

Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities. [ABSTRACT FROM AUTHOR]

Background: Change promotes quality in healthcare, yet adopting change can be challenging. Understanding how change in nutrition care is adopted may support better design and implementation of interventions that aim to address inadequate food intake in hospital. The present study followed the process of change in a healthcare organisation, exploring staff attitudes, beliefs and experiences of the implementation of a mealtime intervention. Methods: In total, 103 h of fieldwork were conducted in this longitudinal ethnographic study over a 4‐month period. Over 170 staff participated, with data captured using observation, interviews and focus groups. Data were analysed using an inductive, thematic approach, informed by implementation theory. Results: Attitudes and experiences of change in nutrition care are described by three themes: (i) staff recognised the inevitability of change; (ii) staff cooperated with the intervention, recognising potential value in the intervention to support patient care, where increased awareness of their mealtime behaviours supported adopting practice changes; and (iii) some staff were able to reflect on their practice after implementing the intervention, whereas others could not. A model illustrating the interconnectedness of factors influencing implementation emerged from the research, guiding future nutrition care intervention design and supporting change. Conclusions: The requirement to address the underlying perceptions of staff about the need to change should not be underestimated. Increased efforts to market the change message to specific staff groups and physical behavioural reinforcement strategies are needed. Nutrition care in the future should focus on helping staff feel positive about making practice changes. [ABSTRACT FROM AUTHOR]

Background: A person‐centred approach to nutritional care has the potential to increase an older person's role in making informed decisions about their own care and possibly improving their quality of life. However, despite the considerable interest shown in person‐centred nutritional care in recent years, delivery of such care still appears to lack consideration for older persons' needs and preferences. The present study aimed to explore healthcare professionals' views on how older persons and their family caregivers participate in decisions about their own nutritional care and possible barriers for that participation. Methods: Semi‐structured in‐depth interviews with 23 healthcare professionals in acute geriatric care and home care were conducted. Data were analysed thematically. Results: The analysis of the interviews resulted in three main themes: (i) lack of shared decision‐making in nutritional care; (ii) conflict between patient's preferences and standard nutritional care procedures; and (iii) the value of family caregivers who are seldom involved in nutritional care. Conclusions: Healthcare professionals were aware of the importance of actively engaging older persons and their family members in the nutritional care to achieve positive outcomes. However, they encountered individual and structural barriers, including resistance from patients and family caregivers, conflicts between the patients' nutritional wishes and standard nutritional procedures, a wish to shield the family caregivers from the stress of caring for a sick relative, and lack of time and caring structures that facilitate the older persons and their family's active participation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the nutrition education provided by primary-care physicians (PCP).Design: An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms.Setting: USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand.Participants: Primary-care physicians.Results: Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations.Conclusions: The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice. [ABSTRACT FROM AUTHOR]

Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students’ perspectives on health professionals’ nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health‑care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors’ advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate nutrition care and nursing professional knowledge received by adults on highly active antiretroviral therapy attending primary health care (PHC) facilities Design: Cross-sectional, descriptive study. Subjects and setting: The study was conducted on 263 adults and 75 nursing professionals, recruited from 19 facilities in the Mbombela sub-district, Mpumalanga. Outcome measures: Interviewer-administered questionnaires were completed for each patient. Nursing professionals completed a self-administered questionnaire. Assessment tools were completed for each facility. Results: Some 41% of patients were either overweight or obese, and most females (n = 87; 51.8%) had a BMI ≥ 25 kg/m2. Based on waist circumference, 52.7% (n = 88) of females and 8.4% (n = 8) of males showed increased risk of cardiovascular disease. Although nurses were aware of a nutrition supplementation programme, knowledge of national nutrition guidelines was inadequate. Clinical judgement, rather than eligibility criteria, was used to identify suitable patients, with 13.3% (n = 35) receiving supplementation whereas only 4.9% (n = 13) qualified. Facilities generally had sufficient equipment and fair storage conditions, but stock shortages of nutrition supplements were problematic. Conclusions: Whilst certain positive findings emerged, nutrition care could be improved, largely through adequate training and support to professional nurses. Training should focus on correct execution of assessment measurements and appropriate nutritional counselling, emphasising balanced eating, food security and prevention of over-nutrition. Nurses should be familiarised with national nutrition guidelines and have access to a constant nutrition supplementation supply. Improved monitoring and evaluation of nutrition care to adults on treatment at PHC facilities is needed.Keywords [ABSTRACT FROM AUTHOR]

Abstract: Background: The present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia. Methods: Two cross‐sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t‐tests, chi‐squared tests and Z‐tests were computed to compare responses from the 2013 and 2016 surveys. Results: The survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported ‘no role’ in eHealth solutions. Conclusions: Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition‐related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness. [ABSTRACT FROM AUTHOR]

Background Active patient involvement in nutrition care may improve dietary intakes in hospital. Our team is developing an innovative programme allowing patients to self-assess and self-monitor their nutrition at the bedside. The present study aimed to assess usability and patient perceptions of an electronic foodservice system ( EFS) for participating in nutrition care. Methods This qualitative study was conducted in an Australian tertiary hospital. Participants were sampled purposively and included patients who were able to provide informed consent and communicate in English. Patient interviews were conducted at the bedside and consisted of: (i) usability testing of the EFS using 'Think Aloud' technique and (ii) questioning using a semi-structured interview guide to understand perceptions of the EFS. Interview data were analysed using inductive content analysis. Results Thirty-two patients were interviewed. Their perceptions of using the EFS to participate in nutrition care were expressed in five categories: (i) Familiarity with technology can affect confidence and ability but is not essential to use EFS; (ii) User interface design significantly impacts EFS usability; (iii) Identifying benefits to technology increases its acceptance; (iv) Technology enables participation, which occurs to varying extents; and (v) Degree of participation depends on perceived importance of nutrition. Conclusions Patients found the EFS acceptable and acknowledged benefits to its use. Several factors appeared to influence usability, acceptability and willingness to engage with the system, such as user interface design and perceived ease of use, benefits and importance. The present study provides important insights into designing technology-based interventions for engaging inpatients in their nutrition care. [ABSTRACT FROM AUTHOR]

Background: Advancements in technology are enabling patients to participate in their health care through self-monitoring and self-management of diet, exercise and chronic disease. Technologies allowing patients to participate in hospital care are still emerging but show promise. Our team is developing a program by which hospitalised patients can participate in their nutrition care. This study explores hospital staffs' perceptions of using this technology to engage patients in their care.Methods: This qualitative study involved semi-structured interviews with hospital staff providing routine nutrition care to patients (i.e. dietitians, nutrition assistants, nurses, doctors and foodservice staff) from five wards at a tertiary metropolitan teaching hospital in Australia. The hospital currently uses an electronic foodservice system (EFS) for patient meal ordering, accessed through personal screens at the bedside. Participants were shown the EFS program on an iPad and asked about their perceptions of the program, with questions from a semi-structured interview guide. Staff were interviewed individually or in small focus groups. Interviews lasted 15-30 min and were audio recorded and later transcribed. Data were analysed using thematic analysis.Results: Nineteen staff participated in interviews. Overall, they expressed positive views of the EFS program and wanted it to be implemented in practice. Their responses formed three themes, each with a number of subthemes: 1) Enacting patient participation in practice; 2) Optimising nutrition care; and 3) Considerations for implementing an EFS program in practice. Staff thought the program would improve various aspects of nutrition care and enable patient participation in care. Whilst they raised some concerns, they focused on overcoming barriers and facilitating implementation if the program were to be adopted into practice.Conclusions: Staff found an EFS program designed to engage patients in their nutrition care acceptable, as they saw benefits to using it for both patients and staff. Staff recognised characteristics of the program itself, as well as allocation of roles and responsibilities in operationalising it, were pivotal for successful implementation in practice. Their perspectives will inform program and intervention design, and implementation and evaluation strategies. [ABSTRACT FROM AUTHOR]

Background: Nutrition is recognized as a strong factor influencing the health outcomes of patients with chronic disease. General practitioners (GPs) require nutrition knowledge and skills to support patients to have healthy dietary behaviours. Objective: To investigate New Zealand GP registrars' provision of nutrition advice using patient scenarios. Study design: A cross-sectional study design targeted GP registrars to investigate the nutrition care they provided to patients. Methods: Fourty-seven GP registrars completed a survey at a training event. The survey included patient scenarios. Respondents were asked to provide nutrition advice for each scenario, in line with best practice guidelines. Responses to each scenario were scored based on a panel of nutrition experts. Regression analysis was used to compare the scores to participants' previously reported confidence to provide nutrition care. Results: Seventeen male (36.2%) and thirty female (63.8%) GP registrars completed the survey, giving a response rate of 92.2%. GP registrars scored a mean of 7.9 ± 0.2 out of 15 for recall of dietary strategies with the scenarios. There was no association between GP registrars' scenario scores and their confidence to provide nutrition care. Conclusions: An evidence-practice gap exists for New Zealand GP registrars' confidence to provide nutrition care, and their knowledge of evidence-based nutritional guidelines to support patients to have healthy dietary behaviours. A better understanding of the determinants of this disparity is required in order to support optimal nutrition care by GPs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of chronic disease is considerable, and dietary behaviours influence the progression of many chronic diseases. Practice guidelines recommend that general practitioners (GPs) promote healthy dietary behaviours in relevant consultations with patients in order to improve health outcomes at a population level. Objective: To describe GPs' perceived interest, confidence and barriers to support patients to have a healthy diet. Method: A 24-item online and written survey was distributed in a national weekly newsletter to GPs in Australia. Results were descriptively analysed and investigated for associations with GPs' demographic characteristics. Results: A total of 322 GPs responded to the survey. Nearly all (n = 295, 91.6%) were interested in supporting patients to eat well, and most (n = 231, 71.7%) reported moderately high confidence for providing nutrition care with clear public health messages for conditions, such as cardiovascular disease. Many GPs (n = 170, 52.8%) cited lack of time as the biggest barrier to providing nutrition care, and the overwhelming majority (n = 289, 89.8%) were interested in receiving additional education and training to enhance their nutrition knowledge and skills. Discussion: Many GPs are interested in nutrition and would benefit from educational programmes that improve their competence to provide nutrition care. Professional development opportunities should focus on the identification of nutritional risk and the promotion of healthy dietary behaviours within the time constraints of a standard consultation. [ABSTRACT FROM AUTHOR]

Patients in primary care (PC) are often counselled on diet, and assessment of current food intake is a necessary prerequisite for individualized nutrition care. This sequential mixed-methods study explored current diet assessment (DA) practices in team-based PC in Ontario, Canada, with interdisciplinary focus groups (FGs) followed by a web-based survey. Eleven FGs (n= 50) discussed key patient groups and health conditions requiring DA, as well as facilitators and barriers to accurate DA. Interpretative analysis revealed three themes: DA as a common activity that differed by health profession, communication of DA results within the team, and nutrition care as a collaborative team activity. A total of 191 providers from 73 Family Health Teams completed the web-based survey, and confirmed that many providers are frequently doing DA and that methods vary by discipline. Most providers conducted DAs every day or almost every day. As expected, dietitians used more formal and detailed methods to assess diet than other disciplines, who were more likely to ask a few pointed questions. These baseline data provide information on the range of current DA practices in team-based PC that can inform development of new, more accurate approaches that may improve counselling effectiveness. [ABSTRACT FROM PUBLISHER]

Aim: To determine the method and extent of health information technology (HIT) utilisation, roles in relation to HIT in the workplace and perceived barriers and benefits of HIT by dietitians in Australia and provide a comparison with dietitians in the USA. Methods: A survey adapted from the 2011 Academy of Nutrition and Dietetics (Academy) was utilised and circulated electronically to Dietitians Association of Australia members and advertised through a professional nutrition website in 2013. The survey encompassed 25 questions on computer access and use, data sources, experience using HIT, organisational involvement and perceived barriers and benefits to HIT. Descriptive statistics, independent t ‐ tests, chi ‐ square tests and z ‐ tests were computed to investigate and compare responses from the 2013 Australian and 2011 Academy surveys. Results: The survey completion rate represented 14.5% of Dietitians Association of Australia members (747) and 5% of Academy members (3342). The Australian and Academy respondents reported similar high levels of comfort using technology, awareness of workplace HIT benefits (such as enhanced time management and improved ability to access data) and low levels of organisational involvement. However, there were a significantly greater number of Academy organisations utilising electronic health records (P < 0.05), and significantly more Academy respondents (55%) reported ‘no barriers’ to using HIT compared with Australians (37%) (P < 0.05). Conclusions: Educational programmes will be central to ensuring dietitians are equipped with technology and information management skills required to be involved in and make informed decisions about dietetic ‐ related HIT projects as these will soon be fundamental to dietetic practice. [ABSTRACT FROM AUTHOR]

Background Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. Methods The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Results Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed <50% of food provided at main meals. Conclusions Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to provide an introduction to nutrition informatics, including a brief history and a rationale of its importance for Australian dietetics. Methods The study method used was a narrative review informed by a literature review and expert consultation with the Academy of Nutrition and Dietetics. Results Nutrition informatics has demonstrated potential to improve efficiencies, reduce costs, support research and ultimately enhance patient care. Governments and organisations have identified this as an emerging priority area. The Dietitians Association of Australia has launched initiatives to advocate and provide strategic advice on dietetic involvement in biomedical informatics and specifically nutrition informatics. Conclusions If nutrition standards and processes are not integrated into information systems, dietitians may inherit technologies that do not support dietetic work practices, and opportunities to enhance nutrition services may be missed. It is recommended that dietitians be aware of the opportunities and potential benefits of nutrition informatics, become familiar and involved in technology initiatives, and take the lead in guiding the development and implementation of technologies that may impact patient nutritional care. [ABSTRACT FROM AUTHOR]

Aim: The global trends of rapid population ageing and increased risk of malnutrition among older people have a tremendous impact on nutrition care for the elderly. The present paper offers an overview of the challenging nutritional needs and problems of the elderly and explores strategies related to nutrition and dietetics to improve care for this particular segment of the population. Methods: A narrative review on monitoring malnutrition and improving food services was undertaken with reference to the literature and drawing on the experience of the author. Results: There is a wide range of problems associated with malnutrition in the elderly that have implications on strategies of intervention for addressing these problems. Conclusions: The current challenges for dietitians include identifying and monitoring the nutritional needs and malnutrition problems of the elderly, improving the quality of food services in health-care facilities, and initiating innovative approaches to nutrition and dietetic services in the community. [ABSTRACT FROM AUTHOR]

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required. [ABSTRACT FROM AUTHOR]

Recently, Nutrition Support Teams (NSTs) has been spreading throughout Japan. Nutritional assessment is important as an initial step among NST activities, since the patients can be identified based on this assessment whether they needs supports by NST or not. Serum trace element is one of the most useful and convenient nutritional indices. The aim of this study is to analyze the relationships between serum trace element values and clinical backgrounds in NST patients by data mining. The subjects of this study consisted of 29 NST patients who were admitted to our hospital between January 2005 and October 2006. Serum trace elements in patients were analyzed by PIXE method. The data were analyzed by a data mining software, i.e. "ICONS Miner" (Koden Industry Co., Ltd.). The significant "if-then rules" were extracted from the decision trees. The target variable of the decision trees is whether nutritional conditions of the patients are improved or not (Yes/No). The explanatory variables of the decision trees are the values in serum trace elements (Fe, Cu, Zn, Se, Mn) and TTR (transthyretin). The analyses demonstrated that the first node of the decision tree was Zn. Therefore, serum Zn value might be the most significant factor among these trace elements in estimating the improvement of nutritional conditions of the patients. In the decision, the second branch was the Fe value, and the Cu the third. The following significant "If-then rules" were extracted from the decision trees. If-then rule 1: If serum Zn value >758.6 µg/l, then improvement of nutritional condition = Y. (1.00 = 9/9) If-then rule 2: If serum Zn value ≤758.6 µg/l and Fe ≤653.2 µg/l and Cu ≤682.5 µg/l, then improvement of nutritional condition = Y. (1.00 = 5/5) If-then rule 3: If serum Zn value ≤758.6 µg/l and Fe ≤653.2 µg/l and Cu >682.5 µg/l and Se >119.8 µg/l, then improvement of nutritional condition = Y. (1.00 = 3/3) In conclusion, data mining analysis of serum trace elements was found to be an effective method in assessing the nutritional conditions in NST patients. [ABSTRACT FROM AUTHOR]

Serum trace elements were analyzed by PIXE method in a patient with acute aortic dissection during the supportive process by a Nutrition support team (NST). The patient was a 53-year old male who suffered from acute aortic dissection on March 1, 2007. He received emergent Bentall operation and bow pars total displacement. Since he suffered from diarrhea as a result of hypoalbuminemia and bowel dysfunction, enteral nutrition was not sufficient to maintain adequate intake. Therefore, we also used parenteral nutrition until the 97th disease day. Afterwards, the patient managed only with enteral nutrition. We measured serum trace elements during these periods. Serum trace elements such as Fe, Zn and Se were preserved within normal ranges. On the other hand, Cu gradually decreased until the 54th disease day (44 μg/l) and stayed in the lower levels around the detection limit until the 109th disease day. Thereafter, Cu slightly increased and reached 117 μg/l on the 131st disease day (reference range of serum Cu in adult males: 700~1,300 μg/l). It was suggested that the serum levels of these trace elements might reflect the nutritional stages of the patient and could be useful as clinical markers for nutritional therapies. [ABSTRACT FROM AUTHOR]

Objective:(1) To develop nutrition education for professionals in dementia wards. (2) To evaluate the effects of education and determine the outcome of the education on the nutrition of aged residents.Design:Educational intervention with before and after measurements. Both the learning outcomes of the professionals and the effect on the aged residents were assessed.Setting:Nursing home residents in dementia wards and professionals.Subjects and methods:Twenty-eight professionals completed half-structured feedback questionnaires that were analysed quantitatively and qualitatively. Assessments of 21 residents' energy and nutrient intake and 19 residents' nutritional status with the MNA before and after the education.Results:The learning process included six half-day training sessions. The professionals learned to use and interpret the MNA and detailed food diaries. Keeping the food diaries and analysing them in multi-professional teams was experienced as the main source for learning insights. After calculating the diets and discussing with others, professionals felt easier about responding to the nutritional problems of the residents. After 1 year, the residents' mean energy intake had increased 21% from 1230 to 1487 kcal. Before the education none but after 1 year 16% had a good nutritional status according to the MNA.Conclusions:We used the constructive learning theory to educate professionals. Keeping and analysing food diaries and reflecting on nutritional issues in small group discussions were effective training methods for professionals. The education had positive effects on the nutrition of the residents in dementia wards.European Journal of Clinical Nutrition (2007) 61, 1226–1232; doi:10.1038/sj.ejcn.1602639; published online 24 January 2007 [ABSTRACT FROM AUTHOR]

Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM. [ABSTRACT FROM AUTHOR]