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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. This 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 health care 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 health care workers during routine antenatal care.

Implementation science (IS) is a young field that seeks to minimize the gap between what we know and what we practice, otherwise known as the "know-do gap." Recently, IS has focused on research that expedites the dissemination of evidence-based knowledge, accelerates the translation of interventions to improve knowledge gaps, shrinks healthcare disparities, enhances care of complex medical conditions, and narrows variation in clinical practice and policy. This article seeks to review theoretical frameworks of IS and demonstrate how IS can be utilized to improve nutrition care. Specific examples in this article include implementation of initiatives to improve documentation of malnutrition, increase provision of oral nutrition supplements, increase use of Enhanced Recovery After Surgery protocols, and increase energy and protein delivery. Clinical nutrition is a growing field with more and more research findings pointing to new therapies. In implementing these new therapies, practitioners should recognize the complex system present in healthcare and lean on IS findings to speed implementation and more rapidly improve clinical outcomes.

AIM Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. METHODS A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures. RESULTS Pre-implementation (n = 365) and post-implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P

Communal dining offers multiple benefits for hospital patients, yet dining rooms may be underutilized in practice. This study aimed to understand and explore staffs' perspectives and experiences of communal dining in subacute care, and the impacts on staff mealtime practice. Using qualitative, ethnographic methodology, 94 hours of fieldwork were conducted across two subacute care wards. Participants were staff involved in nutrition care or present on the ward at mealtimes. Ninety-one semistructured and ethnographic interviews were conducted with 59 staff, and 54 episodes of observation captured more than 190 staff. Interviews and field notes were thematically analyzed using an inductive approach. Three themes were identified: (i) benefits to patients; (ii) logistical and practical challenges; and (iii) supportive cultural factors. While staff recognized how communal dining benefited patients, logistical and practical challenges impacted their ability to facilitate it in practice. Healthcare organizations seeking to embed communal dining into the mealtime routine should recognize that clear delineation of staff roles and responsibilities, and cultural change involving normalization, setting expectations, and collective advocacy may be needed to optimize benefits for patients.

Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.

AIMS: Communication is the main method used by dietitians to conduct their practice. Yet, few evidence-based tools are available to assess dietitians' communication skills to guide skill development. Further, workplace peer review programs for assessment of communication skills are not standard practice. DIET-COMMS is a validated tool to assess dietitians' communication skills in patient consultations. The aims of this study were to implement a workplace peer review program using the DIET-COMMS tool, assess dietitians' communication skills, evaluate inter-rater reliability and dietitian satisfaction. METHODS: Single site study within Australian hospital dietetics department. Training for DIET-COMMS usage was undertaken with assessors (senior dietitians) and dietitians being assessed using an online training package and face-to-face group sessions. The peer review process consisted of two rounds, occurring four to six months apart. The first round was undertaken with two assessors to evaluate inter-rater reliability. An online survey was conducted to evaluate dietitian satisfaction. RESULTS: Seventeen dietitians completed the program. In the first round, 13 of 17 dietitians scored 76% to 100% on the DIET-COMMS tool (median = 85%, interquartile range [IQR] = 77-93). All dietitians scored 76-100% (median = 98%, IQR = 94-100) in the second round, with significantly higher scores compared to the first (98% vs 85%; P-value

Coronavirus disease 2019 (COVID‐19) has changed nutrition care processes in hospitals and in the home setting. This paper summarizes clinician reports on these changed processes, including overall nutrition care, nutrition assessment, enteral nutrition and parenteral nutrition care steps, and food and oral supplement delivery. Also included are teaching, logistics, and personnel issues around changes in the work environment. Use of safe, standardized, evidence‐based processes in the face of altered care patterns is critical.

The accurate diagnosis and subsequent treatment of malnutrition is an essential component of nutrition care because of the known negative impacts of malnutrition on patient outcomes. The detection of malnutrition is influenced by disease-specific characteristics, practice settings, and the availability of resources. This article explores how malnutrition diagnosis through the application of the Global Leadership Initiative on Malnutrition global consensus on malnutrition diagnostic criteria is impacted by the unique characteristics of the heart failure, oncology, and trauma populations.

Background Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults. Methods We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period. Results Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake. Conclusions A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.

Aim: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. Methods: A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). Results: Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. Conclusions: While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.

Aim: Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse-led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods: Data were collected retrospectively for 1 year pre- and prospectively for 1 year post-implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post-implementation nurses in the neurosurgery ward were invited to complete a self-administered questionnaire to investigate attitudes, practices and knowledge. Results: One hundred and thirteen participants, 55 pre- and 58 post-implementation, took part in the study. Significantly more patients received transition feeding (TF) post-implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1-week post-EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post-implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions: A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care.

BACKGROUND Predicting resting metabolic rate (RMR) in mechanically ventilated, critically ill patients is an important part of the nutrition care in such patients. METHODS RMR and associated clinical data from various studies of mechanically ventilated, critically ill patients were combined, and the impact of body size, age, reason for admission, and sedation level were analyzed along with prediction methods of RMR (the American Society for Parenteral and Enteral Nutrition [ASPEN] standards and the Penn State equation). RESULTS Among 826 measurements, trauma patients had a higher RMR than surgical and medical patients (2077 ± 290 vs 1987 ± 282 kcal/d; P < .0001). RMR was not different in sedated vs unsedated patients. Wide ranges of weight (27-374 kg) and age (18-95 years) were captured. The relationships between weight and RMR and RMR and age were curvilinear. For weight-based ratio methods of RMR prediction

Nutrition care is a fundamental component of quality health care provided to patients in hospital, yet little is known about the staff who deliver this care and their interrelationships, and how this impacts nutrition care. In this ethnographic study on two subacute wards, 67 h of fieldwork was conducted over 3 months to explore the relationships, roles, and responsibilities of those involved at mealtimes, and the influence on meal provision. Data were analyzed inductively and thematically. Three themes describing ward culture and staff relationships emerged: (i) defining mealtime roles and maintaining boundaries; (ii) balancing the need for teamwork and having time and space; and (iii) effective communication supports role completion and problem solving. Lack of appreciation of workflow enablers and barriers degraded working relationships between staff with and without central roles at mealtimes. The present study informs health-care organizations on building a culture that supports interprofessional collaboration in nutrition care in the subacute setting. All staff need to be aware of their and others' mealtime roles and responsibilities to support a coordinated approach.

Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes.Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013-2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications.A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%-61%), early postoperative oral feeding (P .001), and mobilization (P .001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11-3.64; P .001) and a trend for LOS5 days (OR 1.40; 95% CI, 1.00-1.96; P = .052). Low compliance to ERAS (70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23-3.24; P .001).ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.

Background: Patient-centred care (PCC) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC. We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations. Methods: The present study used qualitative methods, situated in a constructivist–interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi-structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically. Results: Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health. Conclusions: PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient-centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC. By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient-centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

Background: The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined. The purpose of this clinical guideline is to develop recommendations for the nutrition care of adult patients with ECF. Methods: A systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evalu...

Aim Implementation of the Nutrition Care Process (NCP) into dietetics curricula and clinical internship evaluation in Asian countries is new. Two dietetics faculties from Malaysia and USA collaborated to assimilate NCP into clinical dietetics curriculum and internship evaluation. Methods Dietetic interns under supervised practice in hospitals were assessed using a quantitative NCP-based evaluation tool. This tool organised learning outcomes under NCP knowledge domains and achieved high internal consistency and inter-rater reliability. Using a 5-point Likert scale, interns’ scores measured over a 12-week inpatients training were collated and analysed. Subgroup analysis differentiated strong (Progressers) and weak (Regressers) performers based on a median criterion of averaged NCP component scores. Results Most external hospital sites (75% response rate) utilised the evaluation tool for interns’ assessment. Improvements in NCP knowledge domains were significant by week-9 and week-12 compared to baseline (P 3.5) or ‘Regressers’ ( Step 2, nutrition diagnosis (95% CI: 3.70–4.12, = 0.348) > Step 3, nutrition intervention (95% CI: 3.65–3.96, = 0.332) > Step 1, nutrition assessment (95% CI: 3.77–4.09, = 0.307) > Step 4, monitoring and evaluation (95% CI: 3.72–4.04, = 0.269). Weaker interns achieved maximum scores at week-9 before regressing. Conclusions This study found that the application of an NCP-based evaluation tool successfully tracked interns’ clinical competencies under supervised practice.

Aim: To explore malnutrition screening practices by dietitians working with community dwelling older adults in Australia. Methods: A descriptive cross-sectional online survey of dietitians providing dietetic care to older adults (aged ≥65 years) was conducted in November to December 2014 using a three-part 25-item questionnaire with scaled, closed and open-ended questions. Results: One hundred and thirty-three community dietitians participated in the survey. Seventy-seven percent of them reported malnutrition screening was conducted in the workplace and this was highest in government organisations. The majority of dietitians (75%) reported a screening tool was used and the Malnutrition Screening Tool was most commonly used. Independent of level of experience, the majority of dietitians considered malnutrition screening important and agreed with the need for routine screening. Sixty-six percent of dietitians reported that clients screened and found to be at risk of malnutrition frequently refused nutrition assessment. Conclusion: Reported malnutrition screening practices varied considerably across all organisations and states. Although routine screening for malnutrition risk is recommended, refusal for nutritional assessment after positive screening is common and requires further investigation. It is not clear how the term ‘malnutrition’ is perceived by the elderly and further investigation into their perceptions would be useful, particularly as offer for nutrition care is frequently declined.

Understanding patients' experiences and preferences for health care is important with respect to informing how to provide best-practice, patient-centred care. The present study aimed to explore the perceptions of patients who have been recently diagnosed with type 2 diabetes regarding nutrition care received from dietitians.Ten individuals recently diagnosed with type 2 diabetes participated in three individual semi-structured qualitative telephone interviews: at baseline, then at 3 and 6 months after recruitment. Data were analysed using content analysis at each time point and meta-synthesis of findings over time.Participants' initial interactions with dietitians were challenging and overwhelming as a result of the instructional nature of consultations. Many participants questioned the use of dietary guidelines to inform nutrition care because this was not adapted to the individual. Some participants valued receiving education on topics such as label reading and serving sizes; however, others considered that the nutrition care was rushed and overly directive. Very few participants perceived that an ongoing relationship with a dietitian would be useful, and limited interaction was planned beyond 6 months after diagnosis.These findings suggest that there is considerable opportunity for dietitians to enhance the nutrition care provided to patients with type 2 diabetes. Tailoring of dietary guidelines to individuals, utilising supportive counselling styles, and focusing on open communication in consultations that facilitate ongoing, useful care for patients, may help patients with type 2 diabetes achieve and maintain healthy dietary behaviours.

Aim The Academy of Nutrition and Dietetics has led the development and dissemination of the Nutrition Care Process (NCP), incorporating the Nutrition Care Process Terminology as the standardised language. This research investigates and compares the views of Australian dietitians pre and post NCP implementation to inform development of an NCP implementation package. Methods Dietitians from two hospitals that had undergone informal NCP implementation (post-implementers, n = 35) and three hospitals yet to implement NCP (pre-implementers, n = 35) completed an online questionnaire (ASK NCP) surveying demographics and constructs relating to knowledge, familiarity, confidence, support, value, barriers, training and NCP education. Results Post-implementers had higher knowledge scores (P < 0.05), were more familiar with NCP (P < 0.01), confident to implement (P < 0.01) and supported to use NCP (P < 0.01) than pre-implementers. Lack of knowledge, support, training and resources was identified as a barrier by pre-implementers. Busy workloads and work status were identified as barriers by post-implementers. Pre-implementers felt they had insufficient NCP training; however, if further training and support were to be provided, almost all reported they would be more confident to implement. Keys to successful implementation included allocated time to practice and regular tutorials; support and leadership from their management and NCP department leader; and professional growth through understanding how change could benefit practice. Conclusions The results of the study were used to inform the development of an NCP implementation package. Kotter's eight stages of change were identified as the most appropriate change management model with the framework incorporated into the package development.

Aim Incorporation of the Nutrition Care Process (NCP) and NCP Terminology (NCPt) into clinical dietetics practice is advocated in Australia; however, no evidence-based implementation process exists, which may hinder uptake. Based on formative research findings from the Attitudes Skill Knowledge (ASK) NCP survey and using a change management framework, we developed an implementation package for Australian hospital dietitians. This paper aims to report on the outcome of the pilot evaluation and efficacy of the package. Methods Dietitians from three hospitals (two tests and one control) in Western Australia who had not undergone NCP implementation were recruited. Evaluation occurred through administering the ASK NCP survey pre and post implementation in all subjects and focus groups at test sites. The Mann–Whitney U-test was applied to determine whether the changes in the test group were significantly different to the control group. The Wilcoxon signed rank test was used to determine whether there were significant changes within groups. Focus groups were audio-recorded, transcribed and then analysed for themes by the authors. Results Compared to pre-implementation, the dietitians from the test hospitals had significantly higher NCP knowledge (P = 0.006), were more familiar with NCP (P = 0.01) and NCPt (P = 0.025), and more confident to utilise NCP practice (P = 0.011). Compared to pre-implementation, the control group displayed significantly higher familiarity with NCP and NCPt (P = 0.041); however, significant improvements in other constructs were not observed. No significant difference was observed between groups for all constructs. Conclusions Dietitians found the package useful and would recommend it to Australian hospital dietetic departments.

This article explores parenteral nutrition (PN) not only as a therapy but also as a system of care, highlighting the potential "evidence gaps" in guidelines for PN use. The importance of interdisciplinary nutrition care, error reporting, and data-driven practice changes on improving PN therapy is emphasized. Finally, the American Society for Parenteral and Enteral Nutrition's current and future role in advancing the science, practice, and safety of PN is reviewed.

Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris-Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine

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.

The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) developed a Web-based registry for nutrition care launched in early 2011, initially focusing on the home parenteral nutrition (HPN) patient population. The purpose of Sustain is to collect information regarding the patients and populations who require HPN in the United States, measure outcomes associated with HPN, allow institutional benchmarking against the aggregate data, and publish the findings to improve the quality of care for patients receiving HPN. The registry is open to all sites (hospital and home based) who care for new or existing HPN patients. Preliminary data should be available in early 2012.

The purpose of this review is 2-fold. First, it speculates on future scientific work that will have the greatest effect on clinical practice of nutrition care. Second, it discusses the current and future state of the healthcare system, paying special attention to demographic trends and the future of healthcare reform as it will affect nutrition practice.

Aim: Dietitian and general practitioner collaboration in the nutrition care of a patient is important to assist patients to achieve their nutrition goals. This paper aims to review the published literature on dietitians' correspondence practices with recipient general practitioners regarding nutrition interventions recommended to patients. Methods: A literature search was conducted of publications from 1995 to December 2009. Key words were used to search the electronic databases Medline, CINAHL Plus, ProQuest, PsycINFO and Google Scholar. Twenty papers that addressed this topic were selected by two authors for inclusion in the review. Results: There is evidence that dietitians often fail to provide general practitioners with formalised correspondence that describes dietitians' nutrition interventions with patients. Doctors report they lack patient information via dietitians' correspondence. Information about nutrition care of hospital patients often remains within hospital records. Doctors prefer standardised letter formats with content presented succinctly. The letter should include a nutrition diagnosis, agreed goals, a plan for ongoing dietetic visits and instructions for a general practitioner's supportive actions. Conclusion: Dietitians need skill in drafting reports or letters useful for general practitioners by selecting content of value to doctors and using a suitable style. Implementation of shared electronic records in Australia will facilitate information transfer to help realise collaborative patient care. Further investigations of dietitian–general practitioner correspondence are warranted to determine best practice.

One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and nutritional status of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour nutritional status and dietary intake audit of 3000 adult patients. Participants were evaluated for nutritional risk using the Malnutrition Screening Tool (MST). Those ‘at risk’ underwent nutritional assessment using Subjective Global Assessment (SGA). Dietitians observed participants’ dietary intake at each main meal and recorded mid-meal intake via participant interviews. Intakes were recorded as 0%, 25%, 50%, 75%, or 100% of that offered for each meal during the 24-hour audit. Preliminary results for 1550 participants (males = 853; females = 697), age = 64 ± 17 years and BMI = 27 ± 7 kg/m2. Fifty-five percent (n = 853) of the participants had BMI > 25 kg/m2. The MST identified 41% (n = 636) ‘at risk’ for malnutrition. Of those ‘at risk’, 70% were assessed as malnourished resulting in an overall malnutrition prevalence of 30% (25% moderately malnourished, 5% severely malnourished). One-quarter of malnourished participants (n = 118) were on standard hospital diets without additional nutritional support. Fifty percent of malnourished patients (n = 235) and 40% of all patients (n = 620) had an overall 24-hour food consumption of ≤50% during the 24-hour audit. The ANCDS found that skeletons in the hospital closet continue to exist and that acute care patients continue to have suboptimal dietary intake. The ANCDS provides valuable insight into gaps in existing nutrition care practices.

To describe the process of the development of the Web-based resources to extend nutrition care to mental health patients through existing non-nutrition mental healthcare professionals (case-managers).

BACKGROUND Resting energy expenditure (REE) measurements are optimal for accurate assessment of energy requirements and precise provision of parenteral nutrients. We previously observed significant reduction in REE during a 4-week period in children undergoing hematopoietic stem cell transplantation (HSCT). The goal of this study was to determine if weekly REE measurements could accurately represent changes in REE in the peritransplant period compared with a more frequent standard of daily measurements. METHODS Data are presented from a previously described cohort of 37 children undergoing HSCT. We performed weekly indirect calorimetry on 25 patients; of those 25, we performed daily measurements on a convenience sample of 5 children. The time course of REE was analyzed in each sample by repeated measures regression. RESULTS The REE trend of the 20 weekly participants was similar to that of the 5 daily participants, reaching about 80% of predicted REE at 4 weeks posttransplant, with an average decline of 3.4% per week during 4 weeks. CONCLUSION The results suggest that weekly REE measurements accurately characterize REE changes 4 weeks after HSCT compared with daily measurements. Characterization of these trends using weekly measurements may help guide clinical and nutrition care of these patients.

In weight management interventions, understanding the patient readiness to change is essential in order to design individualized nutrition care plans. The aim of this study is to examine obese/over...

Clinical indicators of nutrition care are needed to help improve patient outcomes. To identify potential indicators of nutrition care, 1 dietitian in a trauma service prospectively documented every immediate action she undertook to prevent or correct an adverse, nutrition-related outcome. A total of 101 acute nutrition interventions were provided with 93 (5.2%) of the 1777 nutrition evaluations conducted over the 10-month period. Patient overfeeding triggered 1 of every 3.5 acute nutrition interventions. Most instances of overfeeding were linked to the lack of an interdisciplinary plan of nutrition care. This was troubling because of the severity of illness among the overfed patients (25% mortality). Other categories that necessitated acute intervention included electrolyte imbalance and underfeeding. Several nutritional problems identified by this study are appropriate for use as rate-based and sentinel event indicators to improve the quality of nutrition care.

Parenteral nutrition (PN) has been identified as a potentially high risk and costly drug therapy that tends to be overused. A continuous quality improvement (CQI) model, FOCUS-PDCA, provided the framework used by our Total Parenteral Nutrition (TPN) Subcommittee to develop processes that reduced inappropriate use of PN, improved the quality of patient care, and reduced costs. Through the application of this process from 1992 to 1996, the use of TPN was reduced by 52%, and a 95% appropriateness level was achieved. The success of this methodology also was reflected, during 1996, in an increased use of enteral nutrition, which peaked to 112% from the initial 1995 baseline measurement and in estimated cost savings of $226,184 from reduced use of TPN. Our experience suggests that patients benefit from an improved nutrition screening and assessment program combined with monitoring and education. Achievement of quality nutrition care is cost effective and can be sustained through a nutrition support protocol tha...

Aim This research aimed to evaluate an online electronic record prototype incorporating the Nutrition Care Process and International Dietetics and Nutrition Terminology. Methods Concept design and programming were conducted to create a prototype from an existing online records program. Twelve dietitians from Perth and surrounds trialled the prototype. Online anonymous questionnaires assessed attitudes and confidence around using the Nutrition Care Process and standardised terminology, current practices and opinions on the prototype. A focus group further investigated topics in more detail. Results Part implementation of the Nutrition Care Process (e.g. nutrition diagnosis only) was reported by 42% of dietitians; the remainder planned to implement in the future. Developing new record systems was identified as the most costly area of implementation, followed by dietitian training. After trialling the prototype, dietitians reported an increase of confidence of 17% in using the terminology if they had access to an electronic system. Focus group discussions indicated dietitians felt the prototype was easy to use, acted as a guide to documenting using the care process and terminology, and would be useful in national e-health records. They expressed interest in using an electronic system for research purposes including quality control, investigating intervention effectiveness and justifying the role of dietitians on a productivity basis. Conclusions Results of this pilot study support the concept that an electronic system using standardised terminology is likely to be well accepted by dietitians, and suggests further development of the prototype into a fully functioning system with scope for national electronic health record interoperability.