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Despite a clinical need, only a few studies have provided information concerning visual estimation training for raters to improve the validity of their evaluations. This study aims to describe the differences in the characteristics of raters who evaluated patients' dietary intake in hospitals using the visual estimation method based on their training experiences.We collected data from three hospitals in Tokyo from August to September 2016. The participants were 199 nursing staff members, and they completed a self-administered questionnaire on demographic data; working career; training in the visual estimation method; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity of and skills of visual estimation. We classified participants into two groups, experienced and inexperienced, based on whether they had received training. Square test, Mann-Whitney U test, and univariable and multivariable logistic regression analysis were used to describe the differences between these two groups in terms of their characteristics; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity and tips used in the visual estimation method.Of the 158 staff members (79.4%) (118 nurses and 40 nursing assistants) who agreed to participate in the analysis, thirty-three participants (20.9%) were trained in the visual estimation method. Participants who had received training had better knowledge (2.70 ± 0.81, score range was 1-5) than those who had not received any training (2.34 ± 0.74, p = 0.03). Score of self-evaluation of method validity of the visual estimation method was higher in the experienced group (3.78 ± 0.61, score range was 1-5) than the inexperienced group (3.40 ± 0.66, p 0.01). Mean total scores of using tips in the visual estimation method in the experienced and inexperienced groups were 19.6 ± 1.76 and 17.9 ± 2.28, respectively (score range was 6-24), differing significantly between the two groups (p 0.01). Multivariable logistic regression revealed that participants who had been trained had adequate knowledge (OR: 2.78, 95% CI: 1.05-7.35) and frequently used tips in visual estimation (OR: 1.85, 95% CI: 1.26-2.73).Trained participants had more required knowledge and they used visual estimation tips more frequently than participants who had not been trained in the visual estimation method. This study provides new evidence for the importance of training clinical staff members to use the visual estimation method appropriately and makes suggestions to improve the validity of the visual estimation method.

Having a late chronotype, that is, the tendency to go to sleep and wake up at later hours, influences an individual's physical and mental health. Despite a few studies noting the association of chronotype with healthy dietary patterns, this relationship remains unclear.This study aimed to describe the association of chronotype with healthful and unhealthful plant-based diet quality in female Japanese undergraduate students.Cross-sectional.A total of 218 female university students in Tokyo, Japan.Healthful and unhealthful plant-based dietary index-Japanese version (hPDI-J and uPDI-J), calculated using the validated brief-type self-administered diet history questionnaire.A five-model stepwise multiple linear regression analysis was conducted. Independent variables were hPDI-J and uPDI-J scores, and dependent variables were various lifestyle habits related to the circadian rhythm and demographic characteristics.Mean (standard deviation) sleep duration, midpoint of sleep, sleep latency time, and social jetlag were 411 (60) min, 03:56 (00:57), 21 (27) min, and 50 (39) min, respectively. Chronotype and several variables, such as residential status, energy and alcohol intake, and nutritional knowledge, were associated with healthful and unhealthful plant-based diet quality. Individuals who had higher hPDI-J scores were more likely to have an earlier chronotype (β = -0.168, P = 0.019) and better nutritional knowledge (β = 0.164, P = 0.022) than those with lower hPDI-J scores. Individuals were more likely to have higher uPDI-J scores if they were living alone (β = -0.301, P 0.001), had a later chronotype (β = 0.181, P = 0.001), higher frequency of snacking (β = 0.164, P = 0.019), lower total energy (β = -0.445, P 0.001), and worse nutritional knowledge (β = -0.172, P = 0.001).This study provided new evidence as to the relationship between sleep and dietary habits, the interaction of which may affect women's health.

BackgroundPostoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels.Material and methodsConsecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort.ResultsWe obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) = -10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery.ConclusionCRP levels predicted using duration of surgery, mean NR, and preoperative CRP levels are likely identical to measured CRP levels on POD1, being associated with major complications after gastrointestinal surgery.

Background Since a high neuraxial block is one of the serious complications in obstetric anesthesia, simulation training is required for the education of rapid diagnosis and treatment of this complication. Objectives This study aimed to evaluate the effects of a simulation study of the high neuraxial block during epidural analgesia for labor pain on pre- and post-simulation tests in junior clinical trainees, who had graduated a medical school within one or two years and being under a two-month program for anesthesia during the Japanese Postgraduate Medical Education. Methods Twenty-two junior clinical trainees participated in this study from September 2016 to May 2017. Before the simulation training, the participants answered a pretest, providing written responses on "how to approach and treat the rapid spread of anesthesia (high neuraxial block) in painless epidural delivery" in a bullet-point form. The number of correct answers to 12 items was counted for each participant. These items were as follows: mask ventilation, preparation for tracheal intubation, oxygenation, supraglottic airway placement, checking the breathing, checking oxygen saturation using pulse oximetry, checking blood pressure, ephedrine injection, checking epidural tube, assessing the level of sensory block, assessing the level of consciousness, and left uterine displacement. After performing our original training, all participants were debriefed and written responses were obtained to a posttest containing the same content as the pretest. Results The percentage of correct answers significantly increased from 8.3 to 16.7% (P = 0.041) after training. The response rates for "mask ventilation" and "check epidural tube" significantly increased from 13.6 to 54.5% (P = 0.004) and from 4.5 to 27.3% (P = 0.039), respectively, after training. Conclusions Simulation training is likely an effective method for junior clinical trainees on studying diagnosis and treatment of high neuraxial block during epidural analgesia in parturient patients.

PurposeVisual estimation, an easy-to-perform technique, is commonly used in hospitals to assess dietary intake in patients. The authors performed a qualitative study where the authors interviewed nurses and dietitians about their perceptions of barriers to accurately measuring patients’ dietary intake in hospitals using the visual estimation method. The paper aims to discuss these issues.Design/methodology/approachTen dietitians and ten clinical nurses responded to 30-minute individual interviews in Tokyo, Japan, in September 2014. Each interview was conducted using a common protocol of open-ended questions focusing on the challenges of the visual estimation method and barriers to accurately measuring patients’ dietary intake as part of their routine work. The tape-recorded interviews were transcribed and analyzed based on grounded theory.FindingsFive main categories emerged: hospitals, meals, colleagues, raters, and patients. Various individual barriers such as skill, attitude, knowledge, and others that had not been considered in previous studies also emerged. External barriers that were out of the raters’ control, such as shortage of time, human resources, financial ability, and others, emerged from the “hospitals” category.Research limitations/implicationsResearch participants were all females and many of them had less than ten years of experience.Practical implicationsIn addition to standardizing the visual estimation process, medical staff need to overcome various other internal and external barriers to accurate measurements.Originality/valueThis is the first study to articulate some important barriers that influence reliability and validity when measuring patients’ dietary intake by visual estimation methods in typical clinical settings.

The aim of this study was to examine differences in the validity of a visual estimation method for determining patients' meal intake between various meal types and supplied food items in hospitals and to find factors influencing the validity of a visual estimation method.There are two procedures by which we obtained the information on dietary intake of the patients in these hospitals. These are both by visual assessment from the meal trays at the time of their clearing, by the attending nursing staff and by weighing conducted by researchers. The following criteria are set for the target trays: A) standard or therapeutic meals, which are monitored by a doctor, for energy and/or protein and/or sodium; B) regular, bite-sized, minced and pureed meal texture, and C) half-portion meals. Visual assessment results were tested for their validity by comparing with the corresponding results of weighing. Differences between these two methods indicated the estimated and absolute values of nutrient intake.A total of 255 (76.1%) trays were included in the analysis out of the 335 possible trays and the results indicated that the energy consumption estimates by visual or weighing procedures are not significantly different (412 ± 173 kcal, p = 0.15). However, the mean protein consumption was significantly different (16.3 ± 6.7 g/tray, p 0.01) between the two procedures. Compared with standard meals (38 ± 45 kcal, 1.9 ± 2.5 g/tray), raters significantly misestimated the energy and protein intake of half-portion meals (78 ± 65 kcal, 2.8 ± 2.2 g/tray, p = 0.01) but accurately estimated the protein intake of protein controlled meals (0.5 ± 0.6 g/tray, p = 0.03). Trays adding supplied food items were significantly misestimated for energy intake (66 ± 58 kcal/tray) compared to trays with no additions (32 ± 39 kcal/tray, p 0.01). Moreover, the results of multivariable analysis demonstrated that supplied food items were significantly associated with increased odds of a difference between the two methods (OR: 3.84; 95% confidence interval [CI]: 1.07-13.85).There were high correlations between the visual estimation method and the weighing method measuring patients' dietary intake for various meal types and textures, except for meals with added supplied food items. Nursing staff need to be attentive to supplied food items.

Nursing staff have an important role in patients’ nutritional care. The aim of this study was to demonstrate how the practice of sharing a patient’s nutritional status with colleagues was affected by the nursing staff’s attitude, knowledge and their priority to provide nutritional care. The participants were 492 nursing staff. We obtained participants’ demographic data, the practice of sharing patients’ nutritional information and information about participants’ knowledge, attitude and priority of providing nutritional care by the questionnaire. We performed partial correlation analyses and linear regression analyses to describe the relationship between the total scores of the practice of sharing patients’ nutritional information based on their knowledge, attitude and priority to provide nutritional care. Among the 492 participants, 396 nursing staff (80.5%) completed the questionnaire and were included in analyses. Mean±s.d. of total score of the 396 participants was 8.4±3.1. Nursing staff shared information when they had a high nutritional knowledge (r=0.36, P

Background In East Asian countries, which have a high prevalence of underweight individuals, there is little information about the association between dietary factors and abnormal glucose tolerance during pregnancy. We examined the association between carbohydrate intake and moderately abnormal glucose tolerance in Japanese pregnant women. Methods We conducted a prospective study on 325 Japanese pregnant women without a diagnosis of diabetes mellitus prior to pregnancy. Dietary carbohydrate intake (% of total energy intake) was assessed using a 3-day dietary record during weeks 8-15 of pregnancy. Glucose tolerance was assessed by the 50 g glucose challenge test (GCT) during weeks 24-28 of pregnancy. A positive GCT result was defined by a 1-hour plasma concentration ≥ 7.8 mmol/L. Odds ratios of a positive GCT were calculated for the top and middle tertile categories of carbohydrate intake using the bottom category as reference. Results Mean (standard deviation) body mass index at the first prenatal visit was 19.7 (1.9) kg/m2 , and 95 women were underweight. Seventy-four women had positive GCT results. Carbohydrate intake was negatively associated with a positive GCT result after adjusting for age, parity, body mass index at first prenatal visit, family history of diabetes mellitus, rate of gestational weight gain, energy intake, and dietary fiber intake (odds ratio for top category: 0.46 [95% CI, 0.23-0.93]). Conclusions These findings suggest that high carbohydrate intake was negatively associated with moderately abnormal glucose tolerance in a population with a high prevalence of underweight individuals.

The accuracy of the visual estimation method is unknown, even though it is commonly used in hospitals to measure the dietary intake of patients. We aimed to compare the difference in the validity of visual estimation according to the raters' job categories and tray divisions, and to demonstrate associations between meal characteristics and validity of visual estimation in a usual clinical setting in a community hospital.We collected patients' dietary intake data in usual clinical settings for each tray in 3 ways: visual estimation by nursing assistants, visual estimation by dietitians, and weighing by researchers (reference method). Dietitians estimated the dietary intake using 2 divisions, namely, whole tray and food items. Then we compared the weights and visual estimation data to evaluate the validity of the visual estimation method.Mean nutrient consumption of target trays was significantly different when using the visual estimation of target trays than when using the weighed method (visual estimation by nursing assistants [589 ± 168 kcal, 24.3 ± 7.0 g/tray, p 0.01], dietitians' whole trays [561 ± 171 kcal, 23.0 ± 6.9 g/tray, p 0.05], food items [562 ± 171 kcal/tray, p 0.05], and dietitians' food items [23.4 ± 7.3 g/tray, p = 0.63]). Spearman's correlations for both methods were very high for energy (ρ = 0.91-0.98, p 0.01) and protein intakes (ρ = 0.88-0.96, p 0.01), respectively. The limits of agreement in the Bland-Altman plot for both dietary intake categories were -121 kcal to 147 kcal/tray and -6.4 g to 7.0 g/tray (nursing assistants, whole division), -122 kcal-106 kcal/tray and -6.7 g to 5.5 g/tray (dietitians, whole divisions), and -82 kcal to 66 kcal/tray and -4.3 g to 3.9 g/tray (dietitians, food items divisions). High intake rate of grains was significantly associated with decreased odds of a difference between two methods based on the nursing assistant's whole tray evaluation (odds ratio [OR]: 0.85; 95% confidence interval [CI]: 0.76-0.94) and the dietitians' whole tray (OR: 0.80; 95% CI: 0.72-0.89) and food items evaluations (OR: 0.64; 95% CI: 0.56-0.73), respectively. In addition, minced meals were also associated with a difference between two methods, for the nursing assistants' whole tray (OR: 3.53; 95% CI: 1.66-7.51) and dietitians' food items (OR: 2.92; 95% CI: 1.37-6.22).Visual estimation by nursing assistants and dietitians correlated highly with the weighing method although the limits of agreement were wide. Nursing assistants and dietitians should pay attention to low consumption and modified texture meals when evaluating dietary intake using the visual estimation method.