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Krznarić Ž, Vranešić Bender D, Blaž Kovač M, Cuerda C, van Ginkel-Res A, Hiesmayr M, Marinho A, Mendive J, Monteiro I, Pirlich M, Musić Milanović S, Kozjek NR, Schneider S, Chourdakis M, Barazzoni R. Clinical nutrition in primary care: ESPEN position paper. Clin Nutr 2024; 43:1678-1683. [PMID: 38471980 DOI: 10.1016/j.clnu.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care.
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Affiliation(s)
- Željko Krznarić
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Darija Vranešić Bender
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Milena Blaž Kovač
- Community Health Centre Ljubljana, Ljubljana, Slovenia; Department of Family Medicine, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annemieke van Ginkel-Res
- European Federation of Associations of Dietitians, Diëtheek The Netherlands, Organization of Primary Care Dietitians, The Netherlands
| | - Michael Hiesmayr
- Center for Medical Data Science, Medical University Vienna, Vienna, Austria
| | - Anibal Marinho
- Department of Intensive Care, Hospital Universitário de Santo António, Porto, Portugal
| | - Juan Mendive
- La Mina Primary Health Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - Isabel Monteiro
- Department of Sciences, University Institute of Health Sciences, CESPU, Gandra, Portugal; 1H-TOXRUN - One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585 -116 Gandra, Portugal
| | | | - Sanja Musić Milanović
- University of Zagreb, Zagreb School of Medicine, Division for Health Promotion, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Stephane Schneider
- Gastroenterology and Clinical Nutrition, Archet University Hospital, Université Côte d'AZUR, Nice, France
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Eglseer D. Development and evaluation of a Massive Open Online Course (MOOC) for healthcare professionals on malnutrition in older adults. NURSE EDUCATION TODAY 2023; 123:105741. [PMID: 36746061 DOI: 10.1016/j.nedt.2023.105741] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/19/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Education about malnutrition in older adults is often lacking in the curricula of healthcare professionals. Massive open online courses (MOOCs) are an innovative form of education that can potentially improve the knowledge of healthcare professionals. OBJECTIVES (1) to describe the development of a MOOC on malnutrition in older adults and (2) to evaluate the MOOC on the basis of knowledge gained. DESIGN The MOOC was developed by following a structured approach. For the evaluation of the MOOC, a cross-sectional descriptive study was conducted. PARTICIPANTS Overall, 1288 nurses, dietitians, medical doctors and other healthcare professionals participated in the evaluation study. METHODS After performing a comprehensive literature review, two dietitians specialised in geriatrics developed a summary of potentially important content of the MOOC. Nine European malnutrition experts from different professional areas were then asked to contribute their expertise. The specific MOOC content was developed based on the recent literature and evidence-based guidelines. For the evaluation of the MOOC, a questionnaire with 41 questions was developed. Results were analysed using descriptive statistics and chi-square tests. RESULTS The final MOOC consists of five modules with 15 learning videos and supplementary material. The percentage of persons with good malnutrition knowledge increased from 76.1 % to 89.9 % (p < 0.001), while the percentage of persons with fair or little malnutrition knowledge decreased (p < 0.001). The course significantly improved the participants' knowledge of specific malnutrition topics, namely, methods and instruments to determine the nutritional status of older people, interventions to improve oral intake, medical nutrition and multidisciplinary cooperation (p < 0.001). Overall, 91.5 % of the participants rated the quality of the course as very good or good. CONCLUSION MOOCs may be an effective tool that can be used to improve knowledge in healthcare professionals. This provides new opportunities for successful multidisciplinary malnutrition management in clinical practice.
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Affiliation(s)
- D Eglseer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4; A, 8010 Graz, Austria.
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Erickson N, Sullivan ES, Kalliostra M, Laviano A, Wesseling J. Nutrition care is an integral part of patient-centred medical care: a European consensus. Med Oncol 2023; 40:112. [PMID: 36881207 PMCID: PMC9992033 DOI: 10.1007/s12032-023-01955-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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Affiliation(s)
- Nicole Erickson
- Comprehensive Cancer Center Munich, Ludwig Maximilian University of Munich Hospital, Munich, Germany.
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK.
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands.
| | - Erin Stella Sullivan
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Marianna Kalliostra
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands
- The European Nutrition for Health Alliance, London, UK
| | - Alessandro Laviano
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost Wesseling
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
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Cuerda C, Muscaritoli M, Chourdakis M, Krznaric Z, Archodoulakis A, Gürbüz S, Berk K, Aapro M, Farrand C, Patja K, Schneider S, Barazzoni R. Nutrition education in medical schools (NEMS) project: Promoting clinical nutrition in medical schools - Perspectives from different actors. Clin Nutr 2023; 42:54-59. [PMID: 36473759 DOI: 10.1016/j.clnu.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND & AIMS Nutrition education is not adequately represented in the medical curriculum, and this prompted the European Society for Clinical Nutrition and Metabolism (ESPEN) to launch the Nutrition Education in Medical Schools (NEMS) Project in 2017. The aim of this original paper was to describe the perspectives of different actors in the promotion of nutrition education in medical schools. METHODS On 11 November 2021, an online meeting was held on this topic, where nine representatives from different backgrounds participated in the scientific programme. More than 640 participants registered to this webinar. RESULTS The different models of Nutrition Education in Medical Schools were introduced by Prof. Cristina Cuerda (Spain) and Prof. Maurizio Muscaritoli (Italy). The students' perspective was given by Ms. Alexandra Archodoulakis (Germany) and Ms. Sila Gürbüz (Turkey), representing the European Medical Students' Association. The dietitian's perspective was given by Dr. Kirsten Berk (The Netherlands), whereas Dr. Matti Aapro (Switzerland) gave the medical doctor (oncology)'s perspective. Ms. Clare Farrand (Australia) gave the WHO perspective and Dr. Kristiina Patja (Finland) explained the healthy lifestyle teaching to medical students. Lastly, Prof. Michael Chourdakis (Greece) and Prof. Zeljko Krznaric (Croatia) hosted the round-table discussion. CONCLUSIONS There was strong agreement among the representatives from different settings joining this ESPEN initiative that increasing nutritional knowledge and skills of young doctors is now possible and will launch a virtuous cycle that will proactively involve all the other healthcare professionals working in the nutritional field.
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Affiliation(s)
- C Cuerda
- Department of Medicine, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - M Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Z Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | | | - S Gürbüz
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - K Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Aapro
- Oncology Department, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland
| | - C Farrand
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - K Patja
- Department of Public Health, Medical Faculty, University of Helsinki, Finland
| | - S Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Universite Cote d'Azur, Nice, France
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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de van der Schueren MA, Jager-Wittenaar H. Malnutrition risk screening: New insights in a new era. Clin Nutr 2022; 41:2163-2168. [DOI: 10.1016/j.clnu.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
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6
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Cárdenas D, Davisson Correia MIT, Hardy G, Ochoa JB, Barrocas A, Hankard R, Hannequart I, Schneider S, Bermúdez C, Papapietro K, Pounds T, Cuerda C, Ungpinitpong W, Toit A, Barazzoni R. Nutritional care is a human right: Translating principles to clinical practice. Nutr Clin Pract 2022; 37:743-751. [DOI: 10.1002/ncp.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Diana Cárdenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism El Bosque University Bogotá Colombia
| | | | - Gil Hardy
- Ipanema Research Trust Auckland New Zealand
| | - Juan B. Ochoa
- Critical Care Medicine Hunterdon Medical Center Hunterdon New Jersey USA
| | | | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food University of Tours Tours France
| | | | - Stéphane Schneider
- Nutrition Support Unit, Gastroenterology and Nutrition Department Archet University Hospital Nice France
| | - Charles Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country Bogotá Colombia
| | - Karin Papapietro
- Nutrition Unit Hospital Clínico de la Universidad de Chile Santiago Chile
| | - Teresa Pounds
- Department of Pharmacy Wellstar Atlanta Medical Center Atlanta Georgia USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Facultad de Medicina Universidad Complutense Madrid Spain
| | | | | | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste Ospedale di Cattinara Trieste Italy
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7
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Nutritional care is a human right: Translating principles to clinical practice. Clin Nutr 2022; 41:1613-1618. [DOI: 10.1016/j.clnu.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
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8
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Hawk VH, Kapounová Z, Krobot M, Spáčílová V, Lagová E, Podborská M, Haldeman L. Student and faculty perceptions of nutrition education in medical school. Clin Nutr ESPEN 2022; 47:351-357. [DOI: 10.1016/j.clnesp.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
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9
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Kronk CA, Everhart AR, Ashley F, Thompson HM, Schall TE, Goetz TG, Hiatt L, Derrick Z, Queen R, Ram A, Guthman EM, Danforth OM, Lett E, Potter E, Sun SD, Marshall Z, Karnoski R. Transgender data collection in the electronic health record: Current concepts and issues. J Am Med Inform Assoc 2022; 29:271-284. [PMID: 34486655 PMCID: PMC8757312 DOI: 10.1093/jamia/ocab136] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/13/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
There are over 1 million transgender people living in the United States, and 33% report negative experiences with a healthcare provider, many of which are connected to data representation in electronic health records (EHRs). We present recommendations and common pitfalls involving sex- and gender-related data collection in EHRs. Our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of EHR population-based studies. We also briefly discuss adequate additions to the EHR considering name and pronoun usage. We add the disclaimer that these questions are more complex than commonly assumed. We conclude that collaborations between local transgender and gender-diverse persons and medical providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
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Affiliation(s)
- Clair A Kronk
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avery R Everhart
- Population, Health, and Place Program, Spatial Sciences Institute, University of Southern California, Los Angeles, California, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Florence Ashley
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Hale M Thompson
- Department of Psychiatry and Behavioral Science, Rush University Medical Center, Chicago, Illinois, USA
| | - Theodore E Schall
- Berman Institute of Bioethics, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teddy G Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurel Hiatt
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Zackary Derrick
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Roz Queen
- Health Information Science, School of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - A Ram
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - E Mae Guthman
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
| | - Olivia M Danforth
- Department of Family Medicine, Samaritan Health Services Geary St. Clinic, Albany, Oregon, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emery Potter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simón(e) D Sun
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Center for Neural Science, New York University, New York, New York, USA
- Department of Neuroscience and Physiology, Neuroscience Institute, NYU Grossman Medical Center, New York, New York, USA
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Ryan Karnoski
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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12
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Cardenas D, Díaz G, Cadavid J, Lipovestky F, Canicoba M, Sánchez P, Álvarez L, Duarte Y, Reyes JGG, de Noyola GM, Maza C, Porbén SS, Bermúdez CE, García Y, Calvo I, Arenas H. Nutrition in medical education in Latin America: Results of a cross-sectional survey. JPEN J Parenter Enteral Nutr 2021; 46:229-237. [PMID: 33735516 DOI: 10.1002/jpen.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. METHODS Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. RESULTS A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students' average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. CONCLUSIONS Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Díaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Jessika Cadavid
- Faculty of Medical Sciences, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Fernando Lipovestky
- Faculty of Medicine, Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Marisa Canicoba
- Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Paola Sánchez
- Faculty of Medicine, Universidad Latina de Costa Rica, San José, Costa Rica
| | - Ludwig Álvarez
- Nutrition department, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Yan Duarte
- Faculty of Medicine, Universidad Estatal de Guayaquil, Guayaquil, Ecuador
| | | | | | - Claudia Maza
- Faculty of Nutrition, Centro Médico Militar, Ciudad de Guatemala, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Sergio Santana Porbén
- Nutrition department, Hospital Pediatrico Docente "Juan Manuel Marquez,", La Habana, Cuba
| | - Charles Elleri Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogotá, Colombia
| | - Yawelida García
- Faculty of Nutrition, Universidad O&M, Santo Domingo, Dominican Republic
| | - Isabel Calvo
- Nutrition service, Hospital General de Tijuana, Tijuana, Mexico
| | - Humberto Arenas
- Integrated Practice Unit on Intestinal Failure, Hospital San Javier, Guadalajara, Mexico
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Cuerda C, Muscaritoli M, Krznaric Z, Pirlich M, Van Gossum A, Schneider S, Ellegard L, Fukushima R, Chourdakis M, Della Rocca C, Milovanovic D, Lember M, Arias-Diaz J, Stylianidis E, Anastasiadis K, Alunni V, Mars T, Hellerman MI, Kujundžić-Tiljak M, Irtun O, Abbasoglu O, Barazzoni R. Nutrition education in medical schools (NEMS) project: Joining ESPEN and university point of view. Clin Nutr 2021; 40:2754-2761. [PMID: 33933741 DOI: 10.1016/j.clnu.2021.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/07/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Nutrition education is not well represented in the medical curriculum. The aim of this original paper was to describe the Nutrition Education in Medical Schools (NEMS) Project of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS On 19 January 2020, a meeting was held on this topic that was attended by 51 delegates (27 council members) from 34 countries, and 13 European University representatives. RESULTS This article includes the contents of the meeting that concluded with the signing of the Manifesto for the Implementation of Nutrition Education in the Undergraduate Medical Curriculum. CONCLUSION The meeting represented a significant step forward, moved towards implementation of nutrition education in medical education in general and in clinical practice in particular, in compliance with the aims of the ESPEN Nutrition Education Study Group (NESG).
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Affiliation(s)
- C Cuerda
- Nutrition Unit. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Z Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - A Van Gossum
- Department of Gastroenterology and Nutritional Support, Hopital Erasme and Institut Bordet, Free University of Brussels, Brussels, Belgium
| | - S Schneider
- Department of Gastroenterology and Nutrition, CHU de Nice, Université Côte D'Azur, Nice, France
| | - L Ellegard
- Sahlgrenska Academy at the University of Gothenborg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Fukushima
- Department of Surgery, Teikyo University School of Medicine, Japan
| | - M Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - C Della Rocca
- Dean of the Faculty of Pharmacy and Medicine, Sapienza University of Rome, Italy
| | - D Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia
| | - M Lember
- Dean of the Faculty of Medicine, University of Tartu, Estonia
| | - J Arias-Diaz
- Dean of the Faculty of Medicine, Complutense University, Madrid, Spain
| | - E Stylianidis
- Vice Rector for Research and Lifelong Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Anastasiadis
- Dean of the School of Medicine, Aristotle University of Thessaloniki, Greece
| | - V Alunni
- Vice Dean of the Faculty of Medicine for Education, Université Côte D'Azur, Nice, France
| | - T Mars
- Vice Dean Erasmus LLP Coordinator, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M I Hellerman
- Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva 49100, Israel
| | - M Kujundžić-Tiljak
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - O Irtun
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - O Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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14
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Is nutrition education in medical schools a Poe's Purloined Letter? Clin Nutr 2020; 39:2940-2941. [PMID: 32675018 DOI: 10.1016/j.clnu.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022]
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15
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Asokkumar R, Salazar E. Nutrition training in residency and fellowship programme: time for a change. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820903746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Despite several measures, the nutrition education during undergraduate and postgraduate training has been identified to be suboptimal. The objective of this study was to assess the nutrition knowledge, attitudes and practice of residents, fellows and teaching faculties, following a reformation in the training curriculum, in a tertiary teaching hospital. Method: We conducted an anonymous survey involving residents, fellows and teaching faculties in medical and surgical speciality. We assessed four domains: (a) recognition, (b) knowledge, (c) application of basic principles of nutritional and (d) attitude towards clinical nutrition during residency and fellowship training. Each domain had five multiple choice questions and the attitude section was assessed using a five-point Likert scale. Result: We distributed the survey to 305 doctors: 265 completed the first three domains and 259 completed all the domains. The overall mean ± SD score between residents (6.5 ± 1.9), fellows (6.8 ± 1.8) and teaching faculties (6.5 ± 2.2) was similar. All scored similarly in the recognition, knowledge and application domain of the questionnaire. When subcategorised, the gastroenterology sub-speciality scored significantly higher than the rest (8.1 ± 2.2 vs. 6.4 ± 1.9, p = 0.001). Sixty-three per cent and 44% of the responders felt there was lack of adequate focus on clinical nutrition training in residency and during daily ward round, respectively. Only 10% of responders felt confident in providing nutritional counselling and treatment for malnourished patients. Conclusion: Our study shows the current nutritional education during residency and fellowship training is still inadequate and falls short in achieving the recommended goals.
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Affiliation(s)
- Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Jager‐Wittenaar H, de Bats HF, Welink‐Lamberts BJ, Gort‐van Dijk D, van der Laan BFAM, Ottery FD, Roodenburg JLN. Self-Completion of the Patient-Generated Subjective Global Assessment Short Form Is Feasible and Is Associated With Increased Awareness on Malnutrition Risk in Patients With Head and Neck Cancer. Nutr Clin Pract 2020; 35:353-362. [PMID: 31134665 PMCID: PMC7078954 DOI: 10.1002/ncp.10313] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We aimed to assess feasibility of self-completion of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) by head and neck cancer patients, and to assess self-reported increased awareness regarding malnutrition risk after self-completion. METHODS Participants were randomized to complete the PG-SGA SF by paper or app. Feasibility was assessed by time needed to complete the PG-SGA SF, perceived difficulty, and help needed during completion. Participants were asked if they knew what malnutrition was (yes/no) and if they could define "malnutrition." They were also asked 9 questions on whether they perceived increased awareness of malnutrition risk after having completed the PG-SGA SF and 2 on their intention to change lifestyle habits. RESULTS Of all participants (n = 59; 65.9 ± 12.6 years; 73% male), 55% completed the PG-SGA SF paper version and 46% the Pt-Global app. Median time needed for self-completion of the PG-SGA SF was 2 minutes 41 seconds (interquartile range: 1 minute 49 seconds-3 minutes 50 seconds). Forty-eight percent needed help with completion, indicating acceptable feasibility. Participants who completed the Pt-Global app needed help significantly more often (66%; 21/32) than those who completed the PG-SGA SF paper version (26%; 7/27) (P = 0.005). All difficulty scores were excellent. For 7/9 questions on malnutrition risk awareness, >50% of the participants answered positively. CONCLUSION The results of this study show that self-completion of the PG-SGA SF by head and neck cancer patients is feasible and that awareness regarding malnutrition risk may increase after completing the PG-SGA SF.
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Affiliation(s)
- Harriët Jager‐Wittenaar
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
| | - Hester F. de Bats
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bertine J. Welink‐Lamberts
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Dorienke Gort‐van Dijk
- Department of DieteticsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Bernard F. A. M. van der Laan
- Department of Otorhinolaryngology/Head & Neck SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Faith D. Ottery
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied SciencesGroningenthe Netherlands
- Ottery & AssociatesLLCOncology Care ConsultantsDeerfieldIllinoisUSA
| | - Jan L. N. Roodenburg
- Department of Maxillofacial SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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Marques-Vidal P, Jankowski P, De Bacquer D, Kotseva K. Dietary measures among patients with coronary heart disease in Europe. ESC EORP Euroaspire V. Int J Cardiol 2020; 302:5-14. [PMID: 31937454 DOI: 10.1016/j.ijcard.2019.12.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess the dietary recommendations provided to patients hospitalized for a coronary heart disease (CHD) event. DESIGN Cross-sectional, multicentre observational study (ESC EORP Euroaspire V). METHODS 8261 participants (25.8% women, 9.3% aged<50 years) from 27 countries, 6 to 24 months after hospitalization for a CHD event were included. Participants were asked if they had been advised to reduce salt, fat or sugar intake, change type of fat consumed, and increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish. Self-reported changes were recorded. RESULTS Advice to reduce energy intake, salt, fat and sugar was provided to 64.5% [range: 9.2-90.5], 73.2% [38.6-95.2], 77.3% [42.3-95.6] and 67.0% [39.4-93.3] of patients, respectively. Advice to change fat type, increase consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish was provided to 68.3% [33.7-92.3], 36.7% [0.6-75.2], 73.2% [39.2-93.6], 66.5% [8.0-90.8] and 53.5% [3.7-83.3] of patients, respectively. Advices were more frequently provided to patients aged 50 to 69, with a high educational level, or obesity. One-eighth [0-55.0] of patients reported having consulted a dietician. Reductions in energy intake, salt, fat and sugar were reported by 57.7% [4.9-81.0], 69.9% [32.1-85.9], 71.8% [40.4-88.4] and 61.2% [29.0-84.0] of patients, respectively. Changes in fat type and increased consumption of plant stanols/sterols, fruit & vegetables, fish and oily fish were reported by 60.9% [4.9-81.0], 25.8% [0.6-54.1], 69.2% [27.7-88.4], 54.8% [4.0-80.1] and 40.4% [2.0-66.8] of patients, respectively. CONCLUSION Dietary advice is not systematically provided to patients with CHD, and considerable differences exist between European countries.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne university hospital, 46 rue du Bugnon, 1011 Lausanne, Switzerland.
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Corneel Heymanslaan 10 (4K3), B-9000 Gent, Belgium.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Republic of Ireland.
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18
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Logan AC, Prescott SL, Katz DL. Golden Age of Medicine 2.0: Lifestyle Medicine and Planetary Health Prioritized. J Lifestyle Med 2019; 9:75-91. [PMID: 31828026 PMCID: PMC6894443 DOI: 10.15280/jlm.2019.9.2.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022] Open
Abstract
The 'golden age of medicine' - the first half of the 20th century, reaching its zenith with Jonas Salk's 1955 polio vaccine - was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive 'personal responsibility' view of health - blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine - including authoritarianism and social dominance orientation - are maintaining an unhealthy status quo.
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Affiliation(s)
- Alan C Logan
- in-VIVO Planetary Health, West New York, NJ, USA
| | - Susan L Prescott
- in-VIVO Planetary Health, West New York, NJ, USA.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - David L Katz
- Yale University, Prevention Research Center, Griffin Hospital, Derby, CT, USA
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Cuerda C, Muscaritoli M, Donini LM, Baqué P, Barazzoni R, Gaudio E, Jezek D, Krznaric Z, Pirlich M, Schetgen M, Schneider S, Vargas JA, Van Gossum A. Nutrition education in medical schools (NEMS). An ESPEN position paper. Clin Nutr 2019; 38:969-974. [DOI: 10.1016/j.clnu.2019.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 01/25/2023]
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20
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Eglseer D, Visser M, Volkert D, Lohrmann C. Nutrition education on malnutrition in older adults in European medical schools: need for improvement? Eur Geriatr Med 2019; 10:313-318. [DOI: 10.1007/s41999-018-0154-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
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Grammatikopoulou MG, Katsouda A, Lekka K, Tsantekidis K, Bouras E, Kasapidou E, Poulia KA, Chourdakis M. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition 2018; 57:69-73. [PMID: 30153582 DOI: 10.1016/j.nut.2018.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Provision of nutritional support (NS) can improve disease outcome and shorten hospital length of stay. NS, often prescribed by medical doctors, requires adequate clinical nutrition (CN) expertise. The aim of this study was to investigate self-perceived and actual CN knowledge among medical doctors in Greece. METHODS Internal medicine physicians and surgical specialties (residents and specialized) were asked to self-evaluate their CN expertise, via a seven-item questionnaire and to complete a 20-question multiple-choice test on CN topics, with the aim of evaluating their actual CN knowledge. Participants were discouraged from accessing literature/information during the completion of either questionnaire. RESULTS Of 182 invited medical doctors, 115 (50.4% surgical specialties) participated in the study (63.2% response rate). The majority of participants (65.2%) demonstrated inadequate CN knowledge, with 30.4% of those scoring low having a high self-perception of their CN expertise. Comparison of perceived and actual CN knowledge revealed that only 56.5% of the participants estimated their knowledge correctly. Those who had participated in CN continuous medical education courses demonstrated increased related expertise (P = 0.002). CONCLUSIONS Medical doctors in Greece demonstrate low knowledge of fundamental CN principles, jeopardizing the provision of high-quality and efficient NS. Most importantly, the majority of participants overestimated their CN knowledge and prescribe artificial nutrition or participate in related decision making. Physicians' CN knowledge should be enhanced accordingly, either by attending CN modules during their studies, by participating in basic and advanced courses or CN-specific continuous medical education, or both.
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Affiliation(s)
- Maria G Grammatikopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Katsouda
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Lekka
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Tsantekidis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Bouras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kasapidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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22
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Roman G, Rusu A, Bala C. Clinical nutrition education in medical schools - Comment on the ESPEN survey. Clin Nutr 2018; 37:1082. [PMID: 29503059 DOI: 10.1016/j.clnu.2018.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Gabriela Roman
- Diabetes and Nutrition Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adriana Rusu
- Diabetes and Nutrition Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Cornelia Bala
- Diabetes and Nutrition Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Cuerda C, Schneider SM, Van Gossum A. Reply, Letter to the Editor - Clinical nutrition education in medical schools - Comment on the ESPEN survey. Clin Nutr 2018. [PMID: 29519564 DOI: 10.1016/j.clnu.2018.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Stéphane M Schneider
- Department of Gastroenterology and Clinical Nutrition, Archet Hospital, University of Nice Sophia Antipolis, Nice, France
| | - André Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
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Adamski M, Gibson S, Leech M, Truby H. Are doctors nutritionists? What is the role of doctors in providing nutrition advice? NUTR BULL 2018. [DOI: 10.1111/nbu.12320] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - S. Gibson
- Monash University; Melbourne Australia
| | - M. Leech
- Monash University; Melbourne Australia
| | - H. Truby
- Monash University; Melbourne Australia
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Wong A, Banks MD, Bauer JD. A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region. Nutrients 2018; 10:nu10020214. [PMID: 29443950 PMCID: PMC5852790 DOI: 10.3390/nu10020214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 12/21/2022] Open
Abstract
Literature regarding the use of home enteral nutrition (HEN) and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs), and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r = 0.63, p = 0.021). High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries.
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Affiliation(s)
- Alvin Wong
- Dietetic and Food Services, Changi General Hospital, Singapore 529889, Singapore.
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia QLD 4072, Queensland, Australia.
| | - Merrilyn D Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia QLD 4072, Queensland, Australia.
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston QLD 4029, Queensland, Australia.
| | - Judith D Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia QLD 4072, Queensland, Australia.
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Undergraduate nutrition education of health professionals in Greek medical, dentistry, pharmacy, nursing and midwifery departments. Clin Nutr 2017; 37:400. [PMID: 29146524 DOI: 10.1016/j.clnu.2017.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/25/2017] [Indexed: 11/20/2022]
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27
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Reply, Letter to the Editor- Undergraduate nutrition education of health professionals in Greek medical, dentistry, pharmacy, nursing and midwifery departments. Clin Nutr 2017; 37:399. [PMID: 29126715 DOI: 10.1016/j.clnu.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 11/20/2022]
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