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Additional file 2: Supplementary file 2. Interview guide patients.

Additional file 1: Supplementary file 1. Interview guide nurses.

Background: About 30% of patients in hospitals are malnourished or at risk of malnutrition. Malnutrition is associated with increased morbidity, longer convalescence, prolonged length of hospital stay, higher readmission rates and premature death. Several barriers are associated with the current practice of nutritional care and treatment in hospitals and the methods are perceived to be cumbersome. Efficient systems and tools to follow up and monitor nutritional care and treatment for the large group of malnourished patients are currently lacking and little is known about the effects and implementation of such systems in clinical practice. Aims: The aim of this PhD thesis was to develop and evaluate a decision support system to prevent and treat disease-related malnutrition in hospitalized patients. We also aimed to explore the readiness and potential barriers to and facilitators of use of such a system and to study the effects of this system in a clinical hospital setting. Methods: A combination of quantitative and qualitative methods was used to investigate the aims. The MyFood decision support system was developed with four main functions: 1) patient registration; 2) dietary recording; 3) evaluation of intake compared with nutritional requirements; and 4) report to nurses, including recommendations for nutritional treatment and a nutrition care plan. To validate the dietary recording function in the MyFood system, 32 hospitalized patients were included and told to record their nutritional intake in the MyFood app for 2 days. Their recordings were compared with digital photographs of the meals combined with partial weighing of meal components. A qualitative study was performed to explore the current practice with nutritional care and treatment in the hospital departments, and barriers and facilitators perceived by health-care professionals for the use of the MyFood system as part of their clinical practice. Four focus groups were conducted with 20 nurses, plus individual interviews with 3 middle managers, 2 physicians and 2 registered dietitians. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guide and analyse the results. To investigate the effects and implementation of the MyFood system in a clinical hospital setting, a randomized controlled trial (RCT) was conducted among 100 patients. The patients assigned to the intervention group were told to use the MyFood system during their hospital stay and the nurses were encouraged to follow up the patients with the system. The control group followed routine care. The patients’ body weight was measured and their body composition estimated twice each week. The Nutritional Risk Screening (NRS 2002) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF) were filled in weekly by the researchers and patients, respectively. Data on nutritional treatment, nutritional documentation and the use of nutrition care plans were gathered from the electronic patient record. Data on length of stay were obtained from the hospital administration system. Results: The MyFood decision support system was developed with an interface consisting of an app for tablet computers and a webserver. The dietary recording function in the MyFood app was found satisfactory in its estimate of the consumption of energy, protein and liquids for the majority of patients. About 70% of the patients had 80% or higher agreement between the estimated intake of energy, protein and liquids based on the MyFood app and the reference method. With regard to the intake of food and beverages, the agreement between the methods varied according to food group. Most of the patients experienced the MyFood app as easy to use and navigate, and reported to become more aware of their nutritional requirements after 2 days’ use. With regard to the current situation with nutritional care and treatment at the hospital departments, the health-care professionals expressed tension for change. The practice deviated from the guidelines for malnutrition in several areas. The MyFood system was perceived as more precise, trustworthy, motivational and fun to use compared with current practice. The use of MyFood was perceived to lead to earlier implementation of nutritional treatment and some thought it would be a time-saver. Potential barriers to the use of MyFood in clinical practice were patients from other cultural backgrounds eating types of food other than the hospital food, patients not speaking Norwegian, hygienic aspects over the use of tablet computers, concerns about the time used to follow up the system and the lack of automatic data transfer to the electronic patient record. In the RCT, the patients allocated to the MyFood group did not differ with regard to change in body weight or body composition during their hospital stay when compared to the control group. Nutritional treatment was documented in the electronic patient records for 81% of the patients in the MyFood group and 57% in the control group (P = 0.019). In the MyFood group, 70% of the patients received a nutrition care plan, whereas the corresponding proportion in the control group was 16% (P = 0.011). Documentation of nutritional intake compared with patient requirements for energy, protein and liquids was present for 84% of the patients in the MyFood group and 4% in the control group (P

We study the algebraic combinatorics of monomial degenerations of Plücker forms which is governed by matching fields in the sense of Sturmfels and Zelevinsky. We provide a necessary condition for a matching field to yield a SAGBI basis of the Plücker algebra for 3-planes in n-space. When the ideal associated to the matching field is quadratically generated this condition is both necessary and sufficient. Finally, we describe a family of matching fields, called 2-block diagonal, whose ideals are quadratically generated. These matching fields produce a new family of toric degenerations of Gr(3,n).Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan.

Bakgrunn og hensikt: Spedbarnstiden preges av rask vekst og utvikling, og et riktig og godt sammensatt kosthold i denne perioden er av stor betydning for barnets helsetilstand. Vekst og ernæringsforhold i tidlige barneår kan også ha betydning for sykelighet og dødelighet senere i livet. En rekke bakgrunnsfaktorer, som utdannelse, mors alder, røyking, antall barn og sivil status, er vist å henge sammen med hvem som følger anbefalingene for spedbarnsernæring. Flere tiltak for å fremme amming og etablere gode kostvaner blant sped- og småbarn er utarbeidet og implementert av norske helsemyndigheter. Blant annet distribueres brosjyrene ”Hvordan du ammer ditt barn” og ”Mat for spedbarn” til spedbarnsforeldre i Norge, og nye anbefalinger for spedbarnsernæring kom i 2001. Med denne masteroppgaven er det ønskelig å se på trend over tid i kostholdet til 6 måneder gamle spedbarn i Norge, kartlegge hvem som følger anbefalingene for spedbarnsernæring, samt evaluere mottak og opplevd nytteverdi av informasjonsmateriell utarbeidet for spedbarnsforeldre. Utvalg, design og metode: Analysene i masteroppgaven er basert på to landsomfattende kostholdsundersøkelser blant 6 måneder gamle spedbarn i Norge; Spedkost 1998 og Spedkost 2006. Utvalg på 3000 spedbarn ble ved begge studietidspunkt invitert til å være med i undersøkelsene. Henholdsvis 2383 og 1986 samtykket til å delta. Semi-kvantitative matvarefrekvensskjema (SFFQ), som skulle beskrive kostholdet fra fødsel og opp til 6 måneders alder, ble benyttet i begge undersøkelsene. Statistiske metoder benyttet i oppgaven er deskriptive analyser og multippel logistisk regresjon. Resultater: I 2006 ble færre spedbarn introdusert for fast føde før 4 måneders alder, flere ble fullammet ved 5 og 6 måneders alder og flere ble introdusert for vitamin D/annet kosttilskudd ved 4 ukers alder, sammenlignet med i 1998. I 1998 ble imidlertid flere spedbarn fullammet og ammet de første leveukene, sammenlignet med i 2006. Andelen ammede barn ved 4 til 6 måneders alder var lik ved de to studietidspunktene, og det var ingen signifikant forskjell mellom andelene som fikk vitamin D/annet kosttilskudd ved 6 måneders alder i 1998 og i 2006. Flere spedbarnsforeldre hadde sett/mottatt informasjonsbrosjyrene ”Hvordan du ammer ditt barn” og ”Mat for spedbarn” i 2006 og flere opplevde brosjyrene som svært nyttig/nyttig i 2006, sammenlignet med i 1998. Røyking og mors utdannelse var de bakgrunnsfaktorene som viste flest signifikante sammenhenger med anbefalingene for spedbarnsernæring. Mors alder og landsdelstilhørighet var faktorer med signifikant assosiasjon med henholdsvis opplevd nytteverdi og mottak av informasjonsmateriell. Opplevd nytteverdi av informasjonsmateriell var signifikant assosiert med ammeslutt