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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]

Background: Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings. Aims and objectives: This scoping review aimed to establish and describe the level of nutrition care provided to older adults admitted and subsequently discharged from EDs. Research design: Systematic searches of nine academic and grey literature databases (Medline (Ovid), Pubmed, CINAHL Complete (EBSCOhost), EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and four websites (Google, Google Scholar, NICE and LENUS) for relevant professional and organisational publications of research, policy, practice, and guidelines between January 2011 to 2023 were completed. Eligible studies included a population of older adults (≥ 65 years) with an ED attendance and subsequent community discharge, and where nutrition screening had identified malnutrition. Data were extracted on the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model and summarised descriptively. Results: Overall, 22 studies were included in the review. Nutrition status was screened on admission to the ED using validated tools: Mini Nutritional Assessment-Short Form (n = 13), Malnutrition Universal Screening Tool (n = 2), Short Nutritional Assessment Questionnaire (n = 2), NRS-2002 (n = 1) and the Mini Nutritional Assessment – Full Form (n = 1). A full nutrition assessment was reported by 5 studies. Only one study referred to documentation of malnutrition in healthcare records. Subsequent nutrition intervention after discharge from the ED for older adults was not described in any study. Conclusion: While there is evidence to support malnutrition screening is taking place in EDs, there is a lack of information about subsequent nutrition care including assessment and therapy interventions. This points to the need for comprehensive exploration of nutrition care pathways, practice, policy, and research to inform models of integrated care for older persons. [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]

Abstract Background Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings. Aims and objectives This scoping review aimed to establish and describe the level of nutrition care provided to older adults admitted and subsequently discharged from EDs. Research design Systematic searches of nine academic and grey literature databases (Medline (Ovid), Pubmed, CINAHL Complete (EBSCOhost), EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and four websites (Google, Google Scholar, NICE and LENUS) for relevant professional and organisational publications of research, policy, practice, and guidelines between January 2011 to 2023 were completed. Eligible studies included a population of older adults (≥ 65 years) with an ED attendance and subsequent community discharge, and where nutrition screening had identified malnutrition. Data were extracted on the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model and summarised descriptively. Results Overall, 22 studies were included in the review. Nutrition status was screened on admission to the ED using validated tools: Mini Nutritional Assessment-Short Form (n = 13), Malnutrition Universal Screening Tool (n = 2), Short Nutritional Assessment Questionnaire (n = 2), NRS-2002 (n = 1) and the Mini Nutritional Assessment – Full Form (n = 1). A full nutrition assessment was reported by 5 studies. Only one study referred to documentation of malnutrition in healthcare records. Subsequent nutrition intervention after discharge from the ED for older adults was not described in any study. Conclusion While there is evidence to support malnutrition screening is taking place in EDs, there is a lack of information about subsequent nutrition care including assessment and therapy interventions. This points to the need for comprehensive exploration of nutrition care pathways, practice, policy, and research to inform models of integrated care for older persons.

Abstract 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.

Organization of food services within hospitals has been identified as a determinant of hospitalized patients' nutritional intake and associated food waste. Whereas hospital food service systems in the Netherlands traditionally consist of 3 fixed mealtimes each day, we recently implemented a new 3-channel concept that provides patients the opportunity to order extra meals or snacks in-between their 3 main mealtimes or even have dinner with their visitors in a bistro located on their ward. This study investigates the impact of transitioning from a traditional paper-based to a patient-centered, digital hospital food service system on food waste production patterns and its associated financial implications. Plate waste (served but uneaten food) measurements were performed at baseline for all served meals during a one-week period within the traditional system and follow-up measurements were conducted annually after implementation of the new system during 3 consecutive years. Measurements were conducted at two hospital floors, each comprising four wards. Average grams of plate waste per served meal, daily meal frequency per patient and the associated production and disposal costs of the collected waste were calculated and compared between the two systems. A total of 4361 meals served within the traditional system were compared with 7815 meals served within the new digital system. Meal frequency increased from an average of 2.5 meals per patient per day in the old system to an average varying between 3 and 3.3 meals per patient per day in the consecutive years. Within the traditional system, average plate waste was 81 grams per served meal, whilst it ranged between 33 and 49 grams per served meal during the following years, with the 3-channel concept in place (p < 0.001, p = 0.010). Dinner demonstrated the largest reduction in plate waste at all measurement points. Following this reduction of plate waste, estimated associated costs of plate waste production and disposal decreased in a similar pattern. Transitioning from a traditional, paper based to a patient-centered and digital hospital catering system results in significantly higher daily meal frequency and less food waste per served meal. [ABSTRACT FROM AUTHOR]

Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0–4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population. [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]

Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Chronic Energy Deficiency (CED) in pregnant women raises the risk of premature birth and low birth weight (LBW). This study evaluates the effectiveness of nutrition mentoring by dietetic students on the knowledge, intake, and nutritional status of pregnant women in Makassar and Maros, South Sulawesi. Conducted as part of the 2023 Dietitian Professional Education Program at Makassar Health Polytechnic, the study used a pretest-posttest design without a control group. Nutrition mentoring was provided through home visits three times a week for two weeks, involving 122 pregnant women with CED. Data were collected via structured interviews and 24-hour recalls, then analyzed using SPSS. The results showed significant improvements: nutrition knowledge increased from 49.9 to 88.6, and energy, protein, fat, and carbohydrate intake rose significantly (p

The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform "SurveyMonkey version 4.1.1". The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation. [ABSTRACT FROM AUTHOR]

Resources are needed to aid healthcare providers and families in making end-of-life nutrition care decisions for residents living in long-term care settings. This scoping review aimed to explore what is reported in the literature about resources to support decision-making at the end of life in long-term care. Four databases were searched for research published from 2003 to June 2023. Articles included peer-reviewed human studies published in the English language that reported resources to support decision-making about end-of-life nutrition in long-term care settings. In total, 15 articles were included. Thematic analysis of the articles generated five themes: conversations about care, evidence-based decision-making, a need for multidisciplinary perspectives, honouring residents' goals of care, and cultural considerations for adapting resources. Multidisciplinary care teams supporting residents and their families during the end of life can benefit from resources to support discussion and facilitate decision-making. [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]

Background: Many intensive care unit (ICU) survivors suffer long‐term health issues that affect their quality of life. Nutrition inadequacy can limit their rehabilitation potential. This study investigates nutrition intake and support during ICU admission and recovery. Methods: In this prospective cohort study, 81 adult ICU patients with stays ≥48 h were included. Data on dietary intake, feeding strategies, baseline and ICU characteristics, and 1‐year outcomes (physical health and readmission rates) were collected. The number of patients achieving 1.2 gram per kilogram per day of protein and 25 kilocalories per kilogram per day at 3 months, 6 months, and 12 months after ICU admission was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutrition intake at 12 months were evaluated, along with the effect of inadequate intake on outcomes. Results: After 12 months, only 10% of 60 patients achieved 1.2 g/kg/day protein intake, whereas 28% reached the advised 25 kcal/kg/day energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (P = 0.003, P = 0.012, and P = 0.033, respectively) and energy intake at 3 months (P = 0.003). A positive relation was found between female sex and energy intake at 12 months after ICU admission (β = 4.145; P = 0.043) and taste issues were independently associated with higher protein intake (β = 0.363; P = 0.036). However, achieving upper‐quartile protein or energy intake did not translate into improved physical health outcomes. Conclusion: Continuous and improved nutrition care is urgently needed to support patients in reaching nutrition adequacy. [ABSTRACT FROM AUTHOR]

Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. Objectives: This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. Methods: This project adopted a pre–post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M‐KAP) questionnaire were performed before and after implementation. Results: There were fewer older adults with poor intake in the post‐implementation group than the pre‐implementation group. Among those at risk of malnutrition, older adults in the post‐implementation group had higher average intake of all provided meals as well as the protein‐dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge‐Attitude subscale and Practice subscale of the M‐KAP questionnaire. Conclusions: Integrating a nurse‐driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. Implications for Practice: Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food‐promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed. [ABSTRACT FROM AUTHOR]

Abstract 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

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]

Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019–2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann–Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling. [ABSTRACT FROM AUTHOR]

Summary: Nutritional care has recently been recognized as a human right to promote access to optimal and timely nutritional care and help reduce disease related malnutrition. The patient who is endangered or suffering from malnutrition is highly vulnerable and at risk of having their human dignity affected. International declarations (of Vienna and Cartagena) have proposed and recognized nutritional care as an emerging human right, and the ethical duty of the nutrition support professional is to ensure access to it through care, responsibility, and justice. The purpose of this paper is to reflect the ethical implications of care, responsibility, and justice as foundations of ethical duty, the ethical implications of lack of access to nutritional care, and the possible solution in generating ethical awareness and education about nutritional care, based on the Vienna and Cartagena Declaration.

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]

Abstract 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

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]

Abstract A multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefits, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufficient. The experts agreed on actions needed to increase evidence quality on SPN use in specific patients at a given time point during acute critical illness or recovery.

Aim: The study was conducted to assess the factors influencing the state of nutrition care in the Inpatient Therapeutic Unit of Hoima Regional Referral Hospital. Methods: The study design used was a cross-sectional and retrospective study. Random sampling was used to select the participants. A questionnaire was used to draw data which was analyzed in Excel, and means, percentages, graphs, and charts were extracted. Results: The unit had 15 staff members, mostly (60%) female, and had no doctor. The staff members were mainly (33%) nurses and (13%) nutritionists. Most of the caretakers (93%) were females and were mainly peasants, single mothers and primary school drops 93%, 64%, and 57% respectively. Fevers (93%) and cough (64%) were the leading complaints, affecting (93%) and (64%) of the patients respectively. Septicaemia (79%) and malaria (50%) were the most common comorbidities, affecting 79% and 50% of the patients, respectively. Conclusions: The study established that knowledge, attitude, and practices had a great influence on the state of nutrition care in the in-patient therapeutic unit. It was also recognized that comorbidities had a significant influence on the treatment outcome of the patients. Nutrition care remained multi-dimension, requiring multi-stakeholder approaches. Recommendations: Establish a functional multi-stakeholder Quality Improvement Committee (QIC) to guide the operations of the unit.

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]

Abstract Background Dietary modifications are considered a first-line intervention for chronic disease management, yet graduating doctors still report not feeling competent to counsel patients on their diet. Research has focused on methods to address this shortfall in physician competency, including culinary medicine. Culinary medicine is an approach to education that involves hands-on food and cooking learning experiences to equip participants with tools for improving the nutrition behaviour and health of their future patients. Despite positive findings in the efficacy of these interventions, they differ markedly in approach and target, which therefore fails to provide adequate evidence that could serve to guide future culinary medicine interventions. Objective A scoping review to synthesize the existing literature on culinary medicine interventions that are offered during medical training. Methods Online databases were used to identify literature published prior to April 2022 that involve a hands-on culinary medicine component to nutrition and examine academic impact, feasibility and acceptability. Results Twenty-four studies met the eligibility criteria. Despite promising gains in nutrition knowledge, confidence and high acceptability of the programs, large variations exist in delivery method, setting, and course content between programs. There is a lack of program cost reporting and long-term follow up of participants, inconsistent evidence for improved nutrition attitudes amongst participants, as well as geographically limited adoption of such programs. Conclusions The findings of this research demonstrate a clear increase in interest in the use of hands-on culinary medicine programs as educational tools, evidence of feasibility in implementation, and improved student nutritional knowledge, skill and counseling compared to a traditional didactic curriculum. The quality of culinary medicine research studies is increasing and the aims of research are narrowing to focus on how culinary medicine can positively impact medical education. The findings from this review will aid in legitimising culinary medicine as an effective delivery method of nutritional education in medical programs.

Abstract Background Emerging findings highlighted the associations of mental illness to nutrition and dysbiosis in the intestinal microbiota, but the underlying mechanisms, especially in schizophrenia (SZ), remain unclarified. Methods We conducted a case-control study of SZ patients (case to control=100:52) by performing sequencing of the gut metagenome; measurement of fecal and plasma non-targeted metabolome; including short-, medium-, and long-chain fatty acids; and targeted metabolites, along with recorded details of daily intakes of food. Results The metagenome analysis uncovered enrichment of asaccharolytic species and reduced abundance of carbohydrate catabolism pathways and enzymes in the gut of SZ patients, but increased abundance of peptidases in contrast to their significantly reduced protein intake. Fecal metabolome analysis identified increased concentrations of many protein catabolism products, including amino acids (AAs), urea, branched short-chain fatty acids, and various nitrogenous derivates of aromatic AAs in SZ patients. Protein synthesis, represented by the abundance of AA-biosynthesis pathways and aminoacyl-tRNA transferases in metagenome, was significantly decreased. The AUCs (area under the curve) of the diagnostic random forest models based on their abundance achieved 85% and 91%, respectively. The fecal levels of AA-fermentative enzymes and products uniformly showed positive correlations with the severity of psychiatric symptoms. Conclusions Our findings revealed apparent dysbiosis in the intestinal microbiome of SZ patients, where microbial metabolism is dominated by protein fermentation and shift from carbohydrate fermentation and protein synthesis in healthy conditions. The aberrant macronutrient metabolism by gut microbes highlights the importance of nutrition care and the potential for developing microbiota-targeted therapeutics in SZ.

Patients with foregut tumors are at high risk of malnutrition. Nutrition care focuses on identifying individuals at risk of malnutrition and optimizing nutrient intake to promote the maintenance of body weight and lean body mass. This multi-center prospective, longitudinal study audited nutrition care practices related to screening for risk of malnutrition (Patient-Generated Subjective Global Assessment Short Form; PG-SGA SF), and nutrition interventions prescribed (route; adequacy of energy and protein intakes). Audits occurred at four time periods: baseline (before treatment) and at 2, 4, and 6 months after starting cancer treatment; 170 patients (esophageal (ESO; n = 51); head and neck (HN; n = 119)) were enrolled. Nutrition risk (PG-SGA SF score ≥ 4) was prevalent at every time period: HN (baseline: 60%; 6 months 66%) and ESO (77%; 72%). Both groups had significant (p < 0.001) weight losses over the 6 month audit period (HN = 13.2% ESO = 11.4%). Enteral nutrition (EN) was most likely to be prescribed at 2 months for HN and at 4 and 6 months for ESO. Target prescribed energy and protein intakes were not met with any nutrition intervention; although adequacy was highest for those receiving EN. Nutrition care practices differed for HN and ESO cancers and there may be time points when additional nutrition support is needed. [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]

• Problem or issue : Poor nutrition during pregnancy can have negative impacts on both mother and baby, in utero and beyond birth. The provision of high-quality nutrition care by health professionals plays an integral role in achieving optimal nutrition during pregnancy. • What is already known : Australian women have limited knowledge of and adherence to pregnancy nutritional requirements. • What this paper adds : This research highlights the need for increased dietetic services during pregnancy and several key themes specific to improving the provision of nutrition care to pregnant women. Poor nutrition during the antenatal period can contribute to adverse health outcomes for both mother and baby. Despite the importance of nutrition during pregnancy, there is limited research exploring the attitudes and experiences pregnant women possess towards nutrition care, particularly within the Australian context. Existing literature has indicated that pregnant women lack knowledge of and are not adhering to pregnancy related nutrition recommendations. Furthermore, although pregnant women rely on many health professionals for nutrition care, there are deficiencies in both the quality and quantity of care provided. The aim of this meta-aggregative review was to explore the experiences and attitudes pregnant women in Australia have towards nutrition care. Meta-aggregation was used to synthesise qualitative studies. A search strategy was applied to four electronic databases in May 2023.The findings were extracted and synthesised via the JBI approach. A total of 719 studies were identified in the initial database search with seven eligible studies included in the meta-aggregation. From 11 categories, three synthesised findings were developed: (i) approaches to nutrition care delivery matters, (ii) quality and quantity of nutrition care is insufficient, and (iii) pregnant women value nutrition care. This review highlights pregnant women's desires for better nutrition care in Australia, with current provision of nutrition care lacking in quality and quantity. Improved antenatal dietetics services and increased health professional nutrition training is necessary to address these concerns. [ABSTRACT FROM AUTHOR]

Background: Dietary modifications are considered a first-line intervention for chronic disease management, yet graduating doctors still report not feeling competent to counsel patients on their diet. Research has focused on methods to address this shortfall in physician competency, including culinary medicine. Culinary medicine is an approach to education that involves hands-on food and cooking learning experiences to equip participants with tools for improving the nutrition behaviour and health of their future patients. Despite positive findings in the efficacy of these interventions, they differ markedly in approach and target, which therefore fails to provide adequate evidence that could serve to guide future culinary medicine interventions. Objective: A scoping review to synthesize the existing literature on culinary medicine interventions that are offered during medical training. Methods: Online databases were used to identify literature published prior to April 2022 that involve a hands-on culinary medicine component to nutrition and examine academic impact, feasibility and acceptability. Results: Twenty-four studies met the eligibility criteria. Despite promising gains in nutrition knowledge, confidence and high acceptability of the programs, large variations exist in delivery method, setting, and course content between programs. There is a lack of program cost reporting and long-term follow up of participants, inconsistent evidence for improved nutrition attitudes amongst participants, as well as geographically limited adoption of such programs. Conclusions: The findings of this research demonstrate a clear increase in interest in the use of hands-on culinary medicine programs as educational tools, evidence of feasibility in implementation, and improved student nutritional knowledge, skill and counseling compared to a traditional didactic curriculum. The quality of culinary medicine research studies is increasing and the aims of research are narrowing to focus on how culinary medicine can positively impact medical education. The findings from this review will aid in legitimising culinary medicine as an effective delivery method of nutritional education in medical programs. [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]

Malnutrition and frailty are common conditions that impact overall health and function. There is limited research exploring the barriers and enablers to providing coordinated nutrition care to malnourished or frail clients in the community (including transitions from hospital). This study aimed to explore dietitians' experiences and perspectives on providing coordinated nutrition care for frail and malnourished clients identified in the community or being discharged from hospital. Semi-structured interviews with clinical/acute, community, and aged care dietitians across Australia and New Zealand were conducted. Interviews were 23–61 min long, audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Eighteen dietitians participated in interviews, including five clinical, eleven community, and two residential aged care dietitians. Three themes, describing key factors influencing the transition and coordination of nutrition care, emerged from the analysis: (i) referral and discharge planning practices, processes, and quality; (ii) dynamics and functions within the multidisciplinary team; and (iii) availability of community nutrition services. Guidelines advising on referral pathways for malnourished/frail clients, improved communication between acute and community dietitians and within the multidisciplinary team, and solutions for community dietetic resource shortages are required to improve the delivery of coordinated nutrition care to at-risk clients. [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]

As food intake patterns become less structured, different methods of dietary assessment may be required to capture frequently omitted snacks, smaller meals, and the time of day when they are consumed. Incorporating sensors that passively and objectively detect eating behavior may assist in capturing these eating occasions into dietary assessment methods. The aim of this study was to identify and collate sensor-based technologies that are feasible for dietitians to use to assist with performing dietary assessments in real-world practice settings. A scoping review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) framework. Studies were included if they were published between January 2016 and December 2021 and evaluated the performance of sensor-based devices for identifying and recording the time of food intake. Devices from included studies were further evaluated against a set of feasibility criteria to determine whether they could potentially be used to assist dietitians in conducting dietary assessments. The feasibility criteria were, in brief, consisting of an accuracy ≥80%; tested in settings where subjects were free to choose their own foods and activities; social acceptability and comfort; a long battery life; and a relatively rapid detection of an eating episode. Fifty-four studies describing 53 unique devices and 4 device combinations worn on the wrist (n = 18), head (n = 16), neck (n = 9), and other locations (n = 14) were included. Whilst none of the devices strictly met all feasibility criteria currently, continuous refinement and testing of device software and hardware are likely given the rapidly changing nature of this emerging field. The main reasons devices failed to meet the feasibility criteria were: an insufficient or lack of reporting on battery life (91%), the use of a limited number of foods and behaviors to evaluate device performance (63%), and the device being socially unacceptable or uncomfortable to wear for long durations (46%). Until sensor-based dietary assessment tools have been designed into more inconspicuous prototypes and are able to detect most food and beverage consumption throughout the day, their use will not be feasible for dietitians in practice settings.

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]

Large epidemiological data reveal that cancer is progressively becoming a chronic and disabling disease. Implementation in daily practice of early therapies aiming at addressing patients' needs is imperative. Nutrition is a major determinant of patients' quality of life, yet it is frequently neglected. Hopefully, reverting this skeptical clinical approach to nutrition, clinical practice guidelines of nutrition care in patients with cancer have been developed and published by international oncology and nutrition societies. By analyzing the more recent guidelines, it appears that a number of issues may contribute to their insufficient implementation in daily practice. Among them are heterogeneity of recommendations across different guidelines and insufficient robustness of evidence, as well as questionable generalization of recommendations. Future guidelines should aim at providing tumor‐specific recommendations for the whole clinical journey of patients with cancer. Also, new, interesting areas should be covered, including fasting metabolism and circadian rhythmicity. [ABSTRACT FROM AUTHOR]

Large epidemiological data reveal that cancer is progressively becoming a chronic and disabling disease. Implementation in daily practice of early therapies aiming at addressing patients' needs is imperative. Nutrition is a major determinant of patients' quality of life, yet it is frequently neglected. Hopefully, reverting this skeptical clinical approach to nutrition, clinical practice guidelines of nutrition care in patients with cancer have been developed and published by international oncology and nutrition societies. By analyzing the more recent guidelines, it appears that a number of issues may contribute to their insufficient implementation in daily practice. Among them are heterogeneity of recommendations across different guidelines and insufficient robustness of evidence, as well as questionable generalization of recommendations. Future guidelines should aim at providing tumor-specific recommendations for the whole clinical journey of patients with cancer. Also, new, interesting areas should be covered, including fasting metabolism and circadian rhythmicity. [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]

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

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]