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Barcina-Pérez P, Lucas-Abellán C, Abellán-Aynés O, Mercader-Ros MT, Victoria-Montesinos D, Hernández-Sánchez P, Serrano-Martínez A. Assessment of Nutrient Levels Provided by General Hospital Patient Menus: A Cross-Sectional Study Carried Out in the Region of Murcia (Spain). Healthcare (Basel) 2023; 11:2304. [PMID: 37628503 PMCID: PMC10454314 DOI: 10.3390/healthcare11162304] [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: 05/27/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Disease-related malnutrition remains a health problem with a high prevalence that increases the risk of poor patient outcomes, in addition to an elevation of healthcare costs. The aim of this study was to evaluate the nutritional quality of the menus at Ribera Molina Hospital, including their adequacy regarding recommended daily nutrient intakes and the agreement with the theoretical nutrition information provided by catering. The mean levels of energy, macronutrients, vitamins, and minerals provided by the basal, diabetic, and soft diets were calculated through the weighing of plated food served throughout the first 14 days of February 2020. A nutritional overestimation was seen in the nutrition information provided by the catering compared to the values derived from weighing foods (p < 0.01). Despite this, the nutritional content calculated by weighing satisfied the energy and protein requirements of 203 hospitalized patients previously studied in the internal medicine area of the hospital. The mean age of these patients was 62 years, and the main causes of admission were lung, cardiovascular, renal, and digestive diseases. There seems to be an insufficient amount of vitamins E and D, as well as magnesium, on all the menus. A possible insufficient amount of calcium, potassium, zinc, and copper was observed in some of the menus studied. It is necessary to update the hospital prescription manual so the nutritional contents of the diets are accurate and based on the weighted and calculated values to improve the adequacy of diets prescribed to patients.
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Affiliation(s)
- Pablo Barcina-Pérez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
| | - Carmen Lucas-Abellán
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
| | - Oriol Abellán-Aynés
- Faculty of Sport, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain;
| | - María Teresa Mercader-Ros
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
| | - Desirée Victoria-Montesinos
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
| | - Pilar Hernández-Sánchez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
| | - Ana Serrano-Martínez
- Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain; (P.B.-P.); (C.L.-A.); (M.T.M.-R.); (A.S.-M.)
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Trinca V, Duizer L, Keller H. The Hospital Food Experience Questionnaire Predicts Adult Patient Food Intake. CAN J DIET PRACT RES 2023; 84:17-27. [PMID: 36412505 DOI: 10.3148/cjdpr-2022-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Describe food/beverage intake among all patients and those with low meal intake and determine if the Hospital Food Experience Questionnaire (HFEQ), or its shorter version (HFEQ-sv), predicts food intake while considering patient (e.g., gender) and hospital characteristics (e.g., foodservice model).Methods: Cross-sectional study of 1087 adult patients from 16 hospitals in Ontario, Canada. The valid and reliable HFEQ assessed patients' meal quality perceptions. Visual estimation determined overall meal and food/beverage intake using the Comstock method. Binary logistic regressions tested the association between patient and hospital characteristics and whether HFEQ or HFEQ-sv scores added utility in predicting overall meal intake (≤50% vs. ≥75%).Results: Approximately 29% of patients consumed ≤50% of their meal. Models assessing patient and hospital characteristics and either the HFEQ or the HFEQ-sv were significant (LRT(43) = 72.25, P = 0.003; LRT(43) = 93.46, P < 0.001). Men and higher HFEQ or HFEQ-sv scores demonstrated significantly higher odds of ≥75% meal consumption. Considering HFEQ or HFEQ-sv scores explained greater variance in meal intake and resulted in better model fits.Conclusions: The HFEQ and HFEQ-sv predict patient meal intake when adjusting for covariates and add utility in understanding meal intake. Either version can be confidently used to support menu planning and food delivery to promote food intake.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, ON
| | - Lisa Duizer
- Food Science Department, University of Guelph, ON
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, ON.,Schlegel-UW Research Institute for Aging, ON
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Khan A, Malik S, Ahmad F, Sadiq N. The importance of human factors in therapeutic dietary errors of a hospital: A mixed-methods study. PLoS One 2022; 17:e0273728. [PMID: 36006996 PMCID: PMC9409594 DOI: 10.1371/journal.pone.0273728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
An accurate therapeutic diet can help people improve their medical condition. Any discrepancy in this regard could jeopardize a patient’s clinical condition. This study was aimed to determine prevalence of dietary errors among in-patients at an international private hospital’s food department, and to explore causes of error to suggest strategies to reduce such errors in the future. Thus, a sequential explanatory mixed-methods study was carried out. For the quantitative part, secondary data were collected on a daily basis over one-month. For qualitative data, errors arising during the meal flow process were traced to the source on the same day of error followed by qualitative interviews with person responsible. Quantitative data were analyzed in SPSS v.25 as percentages. Qualitative data were analyzed by deductive-inductive thematic analysis. Out of a total of 7041 diets, we found that only 17 had errors. Of these, almost two-thirds were critical. Majority of these errors took place during diet card preparation (52.94%), by dietitians (70.59%), during weekdays (82.35%), breakfasts (47.06%), and in the cardiac care ward (47.06%). The causes identified through interviews were lack of backup or accessory food staff, and employee’s personal and domestic issues. It was concluded that even though the prevalence of dietary errors was low in this study, critical errors formed majority of these errors. Adopting organizational behavior strategies in the hospital may not only reduce dietary errors, but improve patients’ well-being, and employee satisfaction in a long run.
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Affiliation(s)
- Amanullah Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Sidra Malik
- Riphah International University, Islamabad, Pakistan
| | - Fayaz Ahmad
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
- * E-mail:
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Shune S, Barewal R. Redefining the value of snacks for nursing home residents: Bridging psychosocial and nutritional needs. Geriatr Nurs 2022; 44:39-47. [DOI: 10.1016/j.gerinurse.2021.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
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AMARAL YG, PENAFORTE FRDO, ARAÚJO LBD, JAPUR CC. Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To assess and identify factors linked to the accuracy of patients’ food intake estimations through a self-monitoring instrument filled in by the patient. Methods This cross-sectional study approached adult hospital patients subjected to regular or therapeutic diets. The actual food intake percentage was obtained by the ratio between the actual food intake and the amount of food served x 100. Patients had to complete a food chart including 9 circles representing plates of food in percentages (increasing scale of 12.5%) to represent their food intake at lunch and/or dinner. The Bland-Altman method assessed the agreement between the actual and the estimated values. The associations between variables (age, sex, hospitalization day, diet prescription, amount of food served and actual food intake percentage) and the accuracy of the food intake estimation (adequate ±10%, overestimated and underestimated) were evaluated through univariate multinomial logistic regression. Results Ninety-six patients were evaluated (51.0% male; 44.0±15.8 years of age). The Bland-Altman analysis showed good agreement between the actual and the estimated food intake. The actual food intake percentage was the only variable associated with the accuracy of the food intake estimation. Conclusion Most patients (~70%) adequately estimated their food intake using the 9-point food chart tested. Furthermore, the only factor linked to the accuracy of the food intake estimation was the actual food-intake percentage. These findings provide preliminary support for the usefulness of this instrument. However, it must be tested in a representative sample of hospitalized patients.
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Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, Rothenberg E, Rubin D, Siljamäki-Ojansuu U, Vaillant MF, Bischoff SC. ESPEN guideline on hospital nutrition. Clin Nutr 2021; 40:5684-5709. [PMID: 34742138 DOI: 10.1016/j.clnu.2021.09.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022]
Abstract
In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.
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Affiliation(s)
- Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France.
| | - Osman Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elina Ioannou
- Department of Nutrition, Limassol General Hospital, Cyprus
| | - Laila Meija
- Riga Stradins University, Pauls Stradins Clinical University Hospital, Latvia
| | - Karen Ottens-Oussoren
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
| | - Claude Pichard
- Unité de Nutrition, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elisabet Rothenberg
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden, Sweden
| | - Diana Rubin
- Vivantes Netzwerk für Gesundheit GmbH, Humboldt Klinikum und Klinikum Spandau, Berlin, Germany
| | | | | | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Muralidharan S, Acharya A, Mallaiah P, Babu BA. A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery. J Oral Maxillofac Pathol 2021; 25:370. [PMID: 34703139 PMCID: PMC8491340 DOI: 10.4103/0973-029x.325255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.
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Affiliation(s)
| | - Arunkumar Acharya
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Pramila Mallaiah
- Department of Public Health Dentistry, MR Ambedkar Dental College and Hospital, Karnataka, India
| | - B Anil Babu
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Sorensen J, Fletcher H, Macdonald B, Whittington-Carter L, Nasser R, Gramlich L. Canadian Hospital Food Service Practices to Prevent Malnutrition. CAN J DIET PRACT RES 2021; 82:167-175. [PMID: 34286621 DOI: 10.3148/cjdpr-2021-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition.Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions).Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook-serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The "regular menu" (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400 kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150.Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, BC
| | - Heather Fletcher
- Patient Food, Patient Transport and Environmental Services, Unity Health, Toronto, ON
| | - Brenda Macdonald
- Nutrition and Food Services, Nova Scotia Health Authority, Halifax, NS
| | | | - Roseann Nasser
- Department of Nutrition and Food Services, Pasqua Hospital, Saskatchewan Health Authority, Regina, SK
| | - Leah Gramlich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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Trinca V, Duizer L, Keller H. Putting quality food on the tray: Factors associated with patients' perceptions of the hospital food experience. J Hum Nutr Diet 2021; 35:81-93. [PMID: 34080252 DOI: 10.1111/jhn.12929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Perceptions of hospital meal quality can influence patient food intake. Understanding what patients prioritise and what they think of current meals can support menu development. The present study assessed patients' food and food-related priorities for hospital meals and their sensory experience using the Hospital Food Experience Questionnaire (HFEQ). Factors independently associated with the HFEQ were determined. METHODS Cross-sectional study (n = 1087 patients; 16 Ontario hospitals). Patients completed the HFEQ at a single meal. Descriptive statistics determined the importance of food traits and ratings of a served meal using 22 HFEQ questions (five-point Likert scales, total score 110). Bivariate and multivariable linear regression tested the association between patient and hospital characteristics and HFEQ score. RESULTS Most food traits were rated as 'important' (4) or 'very important' (5) by two-thirds or more of patients. Patients typically rated served meal items as 'good' (4). Mean HFEQ score was 90.60 (SD 10.83) and was associated with patient and hospital traits in multivariable analyses (F42,556 = 2.34, p < 0.001). Older and woman-identifying patients were more likely to have a higher score. Foodservice models were associated with HFEQ. Cold-plated rethermed food resulted in the lowest HFEQ. Local food use > 10% was associated with lower HFEQ score, whereas larger hospitals had a higher score. CONCLUSIONS Patients prioritised taste, freshness and food that met their dietary needs. Meal sensory ratings were average. A gap exists between what patients want in hospital meals and what they receive. Attention to patient demographics and food delivery that retains sensory properties and supports choice may increase HFEQ score.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Harari R, Toren O, Tal Y, Ben-Porat T. Food allergy safety: a descriptive report of changing policy in a single large medical center. Isr J Health Policy Res 2021; 10:32. [PMID: 33941273 PMCID: PMC8091511 DOI: 10.1186/s13584-021-00466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background Food allergy can result in life-threatening anaphylaxis and is considered an increasing public health burden. Hospitalized patients are dependent on the hospital menu to meet their nutritional needs; thus, errors in the meals provided can have a substantial impact on patients’ health outcomes. In Israel, no specific policy protocol exists to ensure food allergy safety in the setting of a hospital foodservice system. Objectives This paper has two aims: 1) to provide an in-depth review of food allergy as a major public health concern and 2) to report actions taken in a single large medical center, as an ongoing project that aimed to ensure patients’ safety, and which ended in developing policy on this matter. Results During the years 2017–2019, we initiated several interventions with the goal of achieving food allergy safety and ensuring quality of care for patients with food allergies at Hadassah Hebrew University Medical Center. These included integrating food management safety into the computerized foodservice system, highlighting labels on patients’ food trays, introducing safety checks into the process of food delivery to hospitalized patients; and ensuring the nutritional requirements of patients with allergy restrictions. Moreover, changes were made in specialized menus for patients with various types of food allergy, and specific procedures were implemented regarding enteral feeding, to prevent accidental allergen exposure. All the procedures were incorporated into a written protocol that applies to all hospital employees, and the staff received the relevant training. Conclusions Our experience suggests that methods for food allergy safety should be promoted, and that an established policy and suitable set of guidelines on this matter is required. This clearly mandates collaboration between the various sectors of the hospital, including management and the computer department; and the medical, nursing, dietetics and kitchen staffs. Furthermore, routine ongoing knowledge training programs for medical teams and kitchen staff are crucial for such implementational changes. In a technological world, computerized systems delivering food to hospitalized patients must be adapted such as to create a uniformly safe food environment of healthcare systems, and developing a suitable policy should be prioritized accordingly by hospitals across Israel, with collaboration and synergy between institutions management and the departments of nutrition and patient safety and risk management.
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Affiliation(s)
- Rivki Harari
- Department of Diet and Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Orly Toren
- Department of Patient Safety and Risk Management, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tair Ben-Porat
- Department of Diet and Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. .,Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel.
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Trinca V, Iraniparast M, Morrison-Koechl J, Duizer L, Keller H. Hospital Food Experience Questionnaire (HFEQ): Reliable, valid and predicts food intake in adult patients. Clin Nutr 2021; 40:4011-4021. [PMID: 34144411 DOI: 10.1016/j.clnu.2021.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/31/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Low food intake is a primary contributor to iatrogenic hospital malnutrition and can be influenced by perceptions of poor food quality. Valid and reliable tools to assess the food experience of hospital patients are lacking. This study aimed to determine the internal reliability, convergent construct and predictive validity of the new Hospital Food Experience Questionnaire (HFEQ) and to methodically derive and test a shortened version of the questionnaire (HFEQ-sv). METHODS Data from a multi-site study on 1087 patients from 16 Ontario hospitals were used. The HFEQ was developed to assess the importance of food (n = 6) and food-related (n = 10) traits using a 5-point Likert scale anchored by "not important" (1) and "very important" (5), and ratings of a single meal served (n = 7) using a 5-point Likert scale anchored by "very poor" (1) and "very good" (5). Food intake at the same meal was assessed using visual estimation (0%, 25%, 50%, 75%, 100%). Internal reliability was determined using Cronbach's alpha, and principal components analysis (PCA). Convergent validity was assessed using ordinal logistic regression with a single question on patients' overall meal quality rating. Cross validation was conducted in an attempt to shorten the questionnaire and binary logistic regression determined predictive validity with food intake. RESULTS The HFEQ demonstrated good internal reliability (α = .86), and all but one of the questionnaire items clustered together in PCA, revealing 5 factors. Subscales and the total HFEQ demonstrated convergent validity, with the importance of food taste, choice, easy-to-open packaging, easy-to-eat food and local food provision, in addition to meal ratings of taste, appearance, texture, temperature and combination of food served being associated with the overall meal quality rating (p < .050). These items became the basis for the HFEQ-sv, which was found to independently predict food intake (LRT(42) = 142.17, p < .001). CONCLUSIONS The HFEQ is internally reliable, demonstrates convergent validity with the construct of meal quality and predicts food intake. The 11-item HFEQ-sv promotes feasibility. The HFEQ has potential to be used globally to benchmark and quantify the patient food experience in hospital, contributing to quality improvement strategies that will support food intake among patients.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Maryam Iraniparast
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
| | - Jill Morrison-Koechl
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Duizer
- Food Science Department, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada; Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
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Nurkkala J, Lahtinen S, Ylimartimo A, Kaakinen T, Vakkala M, Koskela M, Liisanantti J. Nutrition delivery after emergency laparotomy in surgical ward: a retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:113-120. [PMID: 33797561 PMCID: PMC8825430 DOI: 10.1007/s00068-021-01659-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Adequate nutrition after major abdominal surgery is associated with less postoperative complications and shorter hospital length of stay (LOS) after elective procedures, but there is a lack of studies focusing on the adequacy of nutrition after emergency laparotomies (EL). The aim of the present study was to investigate nutrition adequacy after EL in surgical ward. METHODS The data from 405 adult patients who had undergone emergency laparotomy in Oulu University Hospital (OUH) between years 2015 and 2017 were analyzed retrospectively. Nutrition delivery and complications during first 10 days after the operation were evaluated. RESULTS There was a total of 218 (53.8%) patients who were able to reach cumulative 80% nutrition adequacy during the first 10 postoperative days. Patients with adequate nutrition (> 80% of calculated calories) met the nutritional goals by the second postoperative day, whereas patients with low nutrition delivery (< 80% of calculated calories) increased their caloric intake during the first 5 postoperative days without reaching the 80% level. In multivariate analysis, postoperative ileus [4.31 (2.15-8.62), P < 0.001], loss of appetite [3.59 (2.18-5.93), P < 0.001] and higher individual energy demand [1.004 (1.003-1.006), P = 0.001] were associated with not reaching the 80% nutrition adequacy. CONCLUSIONS Inadequate nutrition delivery is common during the immediate postoperative period after EL. Oral nutrition is the most efficient way to commence nutrition in this patient group in surgical ward. Nutritional support should be closely monitored for those patients unable to eat. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Juho Nurkkala
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland.
| | - Sanna Lahtinen
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Aura Ylimartimo
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Timo Kaakinen
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Merja Vakkala
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Marjo Koskela
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Janne Liisanantti
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
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Factors associated with patient weight loss and prescribed diet during hospitalization. NUTR HOSP 2021; 38:749-757. [PMID: 33966443 DOI: 10.20960/nh.03249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Objective: the aim of this study was to assess weight loss, diet prescribed, and nutritional status in hospitalized patients, as well as their associated factors. Methods: weight loss during hospitalization, nutritional status, disease type, and prescribed diet were investigated in a retrospective study in 621 hospitalized patients. The chi-squared, Fisher's, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. To identify factors associated with weight loss a logistic regression analysis was performed. The significance level adopted for statistical tests was 5 %. Results: patients who experienced weight loss during hospitalization were associated with longer hospital stays (p < 0.0001; OR = 1.052; 95 % CI = 1.030 to 1.073), malnourishment according to the subjective global assessment (p = 0.0358; OR = 1.520; 95 % CI = 1,028 to 2,248), digestive disorders (p = 0.0081; OR = 3.177; 95 % CI = 1.351 to 7.469), and digestive neoplasms (p = 0.0407; OR = 2.410; 95 % CI = 1.038 to 5.597). Conclusion: weight loss during hospitalization was associated with neoplasms, digestive diseases, malnutrition, and length of stay.
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Rattray M, Desbrow B, Marshall AP, von Papen M, Roberts S. Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study. Nutrition 2020; 84:111015. [PMID: 33183898 DOI: 10.1016/j.nut.2020.111015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Timely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation approach, designed to improve oral intake among postoperative colorectal patients. METHODS A pre/post, mixed-methods pilot study was undertaken at a tertiary teaching hospital in Australia. Patients who had undergone elective colorectal surgery and were admitted to the ward where 10 nutrition-related strategies had been implemented were included. Quantitative data, including patient demographics, timing and type of nutrition consumed, and protein and energy intake were collected pre- and post-intervention via chart audits, direct observations, and verbal clarification. Qualitative data on patient (n = 18) responses to the intervention were collected through one-on-one, semistructured interviews and analyzed using inductive content analysis. RESULTS Sixty-four patients were observed (30 pre- and 34 post-intervention). Significant improvements were seen for the following outcomes (presented as median [interquartile range], pre- versus post-intervention): time (h) to first dietary intake (15.7 [7.4-22.5] versus 4.9 [3.7-14.2]); patient energy intakes (kJ) on day 1 (1719 [947-2200] versus 3530 [2192-5169]) and day 2 (2506 [1071-3749] versus 4144 [2987-5889]); and patient protein intake (g) on day 1 (3.3 [1.8-11.2] versus 30.3 [20-45]) and day 2 (10.8 [3.5-29.9] versus 39.6 [30.7-59]). Prescription of free fluids as first diet type increased from 13% to 79% pre- and post-intervention, respectively. There were no significant differences in time (h) to first solid dietary intake (86.1 [60.1-104] versus 69.2 [46.1-115.5]) and overall proportion of patients who met both their estimated energy and protein requirements while in hospital pre- and post-intervention (22 versus 37%). Patients reported positive experiences with the intervention. CONCLUSION A multifaceted intervention developed using an integrated knowledge translation approach has the potential to improve oral intake in patients who undergo colorectal surgery. A larger-scale trial is required to confirm these findings and assess the effects of the intervention on clinical outcomes and costs.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia.
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Queensland, Australia
| | | | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
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15
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Jensen Nobile D. The 19th John M. Kinney Nestlé Nutrition Awards. Nutrition 2020; 70:110633. [DOI: 10.1016/j.nut.2019.110633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Rattray M, Roberts S, Desbrow B, Marshall AP. Hospital Staffs' Perceptions of Postoperative Nutrition Among Colorectal Patients: A Qualitative Study. Nutr Clin Pract 2019; 35:306-314. [PMID: 31144380 DOI: 10.1002/ncp.10315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND After lower gastrointestinal surgery, few patients start eating within timeframes outlined by evidence-based guidelines or meet their nutrition requirements in hospital. The present study explored hospital staffs' perceptions of factors influencing timely and adequate feeding after colorectal surgery to inform future interventions for improving postoperative nutrition practices and intakes. METHODS This qualitative exploratory study was conducted at an Australian hospital where Enhanced Recovery After Surgery guidelines had not been formally implemented. One-on-one semistructured interviews were conducted with hospital staff who provided care to patients undergoing colorectal surgery. Interviews lasted from 21 to 47 minutes and were audio recorded and transcribed verbatim. Data were analyzed using inductive thematic analysis. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation. RESULTS Eighteen staff participated in interviews, including 9 doctors, 5 nurses, 2 dietitians, and 2 foodservice staff. Staffs' responses formed 3 themes: (1) variability in perceived acceptability of postoperative feeding; (2) improving dynamics and communication within the treating team; and (3) optimizing dietary intakes with available resources. CONCLUSION Staff and organizational factors need to be considered when attempting to improve postoperative nutrition among patients who undergo colorectal surgery. Introducing a feeding protocol, enhancing intraprofessional and interdisciplinary communication, and ensuring the availability of appropriate, nutrient-dense foods are pivotal to improve nutrition practices and intakes.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia.,Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, Australia
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Australia
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Rattray M, Roberts S, Desbrow B, Wullschleger M, Robertson T, Hickman I, Marshall AP. A qualitative exploration of factors influencing medical staffs' decision-making around nutrition prescription after colorectal surgery. BMC Health Serv Res 2019; 19:178. [PMID: 30890125 PMCID: PMC6425714 DOI: 10.1186/s12913-019-4011-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/13/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients' diets after surgery, this study explored factors which influenced medical staffs' decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions. METHODS This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation. RESULTS Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition. CONCLUSIONS Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs' decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD 4222 Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University and Gold Coast Hospital and Health Service, Griffith, QLD 4222 Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD 4222 Australia
| | - Martin Wullschleger
- Department of Trauma, Gold Coast University Hospital, Gold Coast, 4222 Australia
| | - Tayla Robertson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Gold Coast, QLD Australia
| | - Ingrid Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital and Mater Research Institute, University of Queensland, Gold Coast, QLD Australia
| | - Andrea P. Marshall
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, 4222 Australia
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Avelino DD, Maltos AL, Portari GV, Gonçalves ÁDC, da Cunha DF. Vitamin C Status in Hospitalized Adults According to Subjective Global Assessment Method. JPEN J Parenter Enteral Nutr 2018; 43:789-793. [PMID: 30350314 DOI: 10.1002/jpen.1460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The subjective global assessment (SGA) is a powerful tool for nutrition status assessment. Our aim was to compare vitamin C serum levels among patients classified as A, B, or C in the SGA. METHODS One hundred-and-fifty adults in the wards of the University Hospital participated in this study. Besides SGA, all cases were submitted to anthropometry, bioelectrical impedance analysis (BIA), and 24-hour dietary recall. Laboratory data included blood hemoglobin, serum ferritin, serum albumin, transferrin, C-reactive protein (CRP), and vitamin C. Acute phase response was defined by serum CRP > 0.5 mg/dL; low serum vitamin C was defined by serum levels < 0.4 mg/dL. Analysis of variance and χ2 tests were used to compare groups; P < 0.05 was considered significant. RESULTS Patients were diagnosed as SGA A (n = 76), B (n = 38), or C (n = 36) and showed different anthropometry and BIA. The same occurred, respectively, with vitamin C (median; range, in mg/day) intake (55.0; 4.7-140.6 vs 34.0; 10.3-244.2 vs 15.8; 2.3-124.0) and high (%) CRP (88.3 vs 65.8 vs 48.7) and low (%) vitamin C serum levels (21.1 vs 34.2 vs 63.9). CONCLUSION Patients with worst nutrition parameters (SGA C) showed lower ascorbic acid serum levels than those classified as SGA A or B. These results are in accordance with reduced vitamin C intake and the presence of acute phase response.
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Affiliation(s)
- Dewelyn Dias Avelino
- Postgraduate Program in Health Sciences, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
| | - André Luiz Maltos
- Clinical Pathology Unit, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
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Beavan S, Baker R, Sadler H, Collinson A. Improving the nutritional intake of hospital patients: how far have we come? A re-audit. J Hum Nutr Diet 2018; 32:372-384. [PMID: 30334301 DOI: 10.1111/jhn.12607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re-audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015. METHODS Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as 'nutritionally well' (MUST 0) or 'nutritionally vulnerable' (MUST ≥ 1). Individual energy and protein requirements were estimated using weight-based equations. Nutritional intakes were assessed via 24-h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements. RESULTS In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. 'Nutritionally well' patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). 'Nutritionally vulnerable' patients were more likely to meet estimated individual requirements for energy (60%) than the Digest standards (30%) (P = 0.047). CONCLUSIONS The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein-dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.
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Affiliation(s)
- S Beavan
- Department of Nutrition and Dietetics, Cambridge University Hospital, Cambridge, UK
| | - R Baker
- Department of Nutrition and Dietetics, East Sussex Healthcare NHS Trust, Conquest Hospital, St Leonards-on-Sea, UK
| | - H Sadler
- Department of Nutrition and Dietetics, Derriford Hospital, Plymouth, UK
| | - A Collinson
- School of Health Professions, University of Plymouth, PAHC, Plymouth, UK
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Byrnes A, Worrall J, Young A, Mudge A, Banks M, Bauer J. Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study. J Hum Nutr Diet 2018; 31:818-824. [DOI: 10.1111/jhn.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A. Byrnes
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Worrall
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| | - A. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove QLD Australia
| | - A. Mudge
- Internal Medicine and Aged Care; Royal Brisbane and Women's Hospital; Herston QLD Australia
- Institute for Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
- School of Medicine; The University of Queensland; St Lucia QLD Australia
| | - M. Banks
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Bauer
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
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Rattray M, Marshall A, Desbrow B, Roberts S. Feeding Practices and Nutrition Intakes Among Non-Critically Ill, Postoperative Adult Patients: An Observational Study. Nutr Clin Pract 2018; 34:371-380. [PMID: 29877595 DOI: 10.1002/ncp.10103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence-based guidelines (EBG) recommend recommencing oral feeding (liquids and solids) ≤24 hours after surgery. The aims of this study were to determine time to first diet (any) and solid-diet prescriptions, delivery, and intakes among adult, non-critically ill, postoperative patients. METHODS This prospective cross-sectional study included 100 postsurgical patients. Demographic and perioperative dietary-related data were collected from patients' medical records or via direct observation. Dietary intakes were observed for the duration patients were enrolled in the study (from end of surgery to discharge). The amount of energy (kcal) and protein (g) consumed per patient per day was analyzed and considered adequate if it met ≥75% of a patient's estimated requirements. RESULTS 89 and 52 patients consumed their first intake and first solid intake ≤24 hours after surgery, respectively. For their first intake, 53% of patients had clear or free liquids. Median times to first diet prescription (range: 1.3-5.7 hours), delivery (range: 2.1-12.5 hours), and intake (range: 2.2-13.9 hours) were ≤24 hours after surgery for all patient groups. Time to first solid-diet prescription (range: 1.3-77.8 hours), delivery (range: 2.1-78.0 hours) and intake (range: 2.2-78.2 hours) varied considerably. Urologic and gastrointestinal patients experienced the greatest delays to first solid-diet prescription and first solid intake. Only 26 patients met both their energy and protein requirements for ≥1 day during their stay. CONCLUSION While practice appears consistent with EBG recommendations for commencing nutrition (any type) after surgery, the reintroduction of adequate diet requires improvement.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Andrea Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, QLD, Australia.,Gold Coast Health, Southport, QLD, Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia.,Gold Coast Health, Southport, QLD, Australia
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Rattray M, Roberts S, Marshall A, Desbrow B. A systematic review of feeding practices among postoperative patients: is practice in-line with evidenced-based guidelines? J Hum Nutr Diet 2017; 31:151-167. [PMID: 28589624 DOI: 10.1111/jhn.12486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early oral feeding after surgery is best practice among adult, noncritically ill patients. Evidenced-based guidelines (EBG) recommend commencing liquid and solid feeding within 24 h of surgery to improve patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay) outcomes. Whether these EBG are adhered to in usual clinical practice remains unknown. The present study aimed to identify the time to commencement of first oral feed (liquid or solid) and first solid feed among postoperative, noncritically ill, adult patients. METHODS MEDLINE, CINAHL, SCOPUS and Web of Science databases were searched from inception to June 2016 for observational studies reporting liquid and/or solid feeding practices among postoperative patients. Studies reporting a mean/median time to first feed or first solid feed within 24 h of surgery or where ≥75% of patients were feeding by postoperative day one were considered in-line with EBG. RESULTS Of 5826 articles retrieved, 29 studies were included. Only 40% and 22% of studies reported time to first feed and time to first solid feed in-line with EBG, respectively. Clear and free liquids were the first diet types commenced in 86% of studies. When solids were commenced, 44% of studies reported using various therapeutic diet types (e.g. light) prior to the commencement of a regular diet. Patients who underwent gastrointestinal procedures appeared more likely to experience delayed postoperative feeding. CONCLUSIONS Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery.
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Affiliation(s)
- M Rattray
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - S Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia
| | - A Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
| | - B Desbrow
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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