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Hildebrand CA, Patel MB, Tenney AB, Logan JA, Luong KH, Crouch MJ, Osta AE, DeRoo C, Gilliland KO, Harlan TS, Ammerman AS. Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review. TEACHING AND LEARNING IN MEDICINE 2024:1-27. [PMID: 38686837 DOI: 10.1080/10401334.2024.2340977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/22/2024] [Indexed: 05/02/2024]
Abstract
PHENOMENON Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation. APPROACH This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees. FINDINGS The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy. INSIGHTS Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.
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Affiliation(s)
- Caitlin A Hildebrand
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition at Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- University of North Carolina Center for Health Promotion and Disease Prevention, Chapel Hill, North Carolina, USA
| | - Meghana B Patel
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alyssa B Tenney
- Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA
| | - Julia A Logan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Khanh H Luong
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Miranda J Crouch
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amanda E Osta
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Courtney DeRoo
- Department of Health Policy and Management at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kurt O Gilliland
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy S Harlan
- George Washington University School of Medicine, Washington, D.C., USA
| | - Alice S Ammerman
- Department of Nutrition at Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- University of North Carolina Center for Health Promotion and Disease Prevention, Chapel Hill, North Carolina, USA
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Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, Williams K, Yang E. "Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:843-864. [PMID: 38383100 DOI: 10.1016/j.jacc.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
"Food Is Medicine" (FIM) represents a spectrum of food-based interventions integrated into health care for patients with specific health conditions and often social needs. Programs include medically tailored meals, groceries, and produce prescriptions, with varying levels of nutrition and culinary education. Supportive advances include expanded care pathways and payment models, e-screening for food and nutrition security, and curricular and accreditation requirements for medical nutrition education. Evidence supports positive effects of FIM on food insecurity, diet quality, glucose control, hypertension, body weight, disease self-management, self-perceived physical and mental health, and cost-effectiveness or cost savings. However, most studies to date are quasiexperimental or pre/post interventions; larger randomized trials are ongoing. New national and local programs and policies are rapidly accelerating FIM within health care. Remaining research gaps require rigorous, iterative evaluation. Successful incorporation of FIM into health care will require multiparty partnerships to assess, optimize, and scale these promising treatments to advance health and health equity.
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Affiliation(s)
- Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
| | - Karen E Aspry
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Kathryn Garfield
- Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts, USA
| | | | | | - Gladys P Velarde
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kim Williams
- University of Louisville, Louisville, Kentucky, USA
| | - Eugene Yang
- University of Washington School of Medicine, Seattle, Washington, USA
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Salas-Groves E, Alcorn M, Childress A, Galyean S. The Effect of Web-Based Culinary Medicine to Enhance Protein Intake on Muscle Quality in Older Adults: Randomized Controlled Trial. JMIR Form Res 2024; 8:e49322. [PMID: 38349721 PMCID: PMC10900082 DOI: 10.2196/49322] [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: 05/24/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality. OBJECTIVE This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults' muscle strength and mass. METHODS A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group's muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG. RESULTS No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit. CONCLUSIONS This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed. TRIAL REGISTRATION ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978.
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Affiliation(s)
| | - Michelle Alcorn
- Hospitality and Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Shannon Galyean
- Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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Lindsay KL, Kennedy J, Kim D, Kalra A, Parekh NK. Development of a Culinary Medicine Curriculum to Support Nutrition Knowledge for Gastroenterology Fellows and Faculty. Nutrients 2024; 16:404. [PMID: 38337688 PMCID: PMC10857341 DOI: 10.3390/nu16030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Gastroenterologists encounter many nutrition-related disorders in their practice, yet the nutritional needs of patients with chronic gastrointestinal (GI) and liver disease are largely unaddressed by treating physicians, due to suboptimal nutrition education. To address this gap, we developed and piloted a culinary medicine course for a GI fellowship training program. The objective of this study is to describe the development, implementation, and acceptability of the course. A registered dietitian, a chef instructor, and a gastroenterology clinical professor trained in culinary medicine developed the four-class tailored curriculum and delivered the classes remotely. Each class had a theme related to commonly encountered GI disorders and included hands-on meal preparation, a nutrition lecture, and a patient case study discussion. Post-course feedback surveys were disseminated. Twenty-three GI physicians enrolled in the course and the attendance rates in classes 1-4 were 83%, 65%, 61%, and 48%, respectively. Among 15 completed feedback surveys, 80% reported that the class contents were either moderately or extremely useful and all endorsed the curriculum for other gastroenterologists. Future studies of culinary medicine programs tailored to medical specialties should identify strategies to maintain engagement and assess the impact on nutrition knowledge, competencies, and translation of these new skills to clinical practice.
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Affiliation(s)
- Karen L. Lindsay
- Department of Pediatrics, School of Medicine, University of California Irvine, Orange, CA 92686, USA
- Susan Samueli Integrative Health Institute, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA 92617, USA
| | - Jennifer Kennedy
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Daniel Kim
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Ankush Kalra
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
| | - Nimisha K. Parekh
- Division of Gastroenterology, Department of Medicine, School of Medicine, University of California Irvine, Orange, CA 92686, USA
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Thomas OW, Reilly JM, Wood NI, Albin J. Culinary Medicine: Needs and Strategies for Incorporating Nutrition into Medical Education in the United States. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241249379. [PMID: 38711830 PMCID: PMC11072074 DOI: 10.1177/23821205241249379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
In the past decade, medical education has increasingly incorporated evidence-based lifestyle interventions as primary strategies for preventing and managing noncommunicable diseases. This shift embraces the growing recognition of the significant impact of lifestyle on health outcomes, driving diseases including obesity, diabetes, heart disease, and cancer. Now deemed "food is medicine" (FIM), diet-related interventions witnessed integration into healthcare systems and recognition in the United States' White House Conference on Hunger, Nutrition, and Health in 2023. As FIM gains traction, investigating optimal strategies for team-based education becomes essential. Healthcare teams need the necessary knowledge and tools to effectively administer FIM services and collaborate across disciplines, ultimately enhancing disease prevention, chronic disease management, health quality, value, and overall wellness. Culinary medicine (CM), a vital component of FIM, bridges nutrition education, pragmatic culinary skills, and conventional strategies to improve chronic disease management. CM involves experiential learning, imparts practical skills, and encourages behavior change by addressing food-related determinants of health and promoting equitable access. Teaching kitchens serve as physical or virtual learning spaces and as a didactic and experiential method (skills lab), playing a crucial role by integrating culinary, lifestyle, integrative, and conventional medicine. A growing number of medical schools in the United States and globally offer CM education via diverse methods including interest groups, electives, and specialty tracks, encompassing didactic sessions, hands-on kitchen education, and virtual teaching methods. Given the rising demand for CM programs, this article aims to describe, map, and compare existing CM education types in medical education. It provides actionable recommendations for medical schools to establish and expand CM programs by fostering service-learning partnerships, clinical innovation, and interdisciplinary research. As FIM gains prominence, cultivating a robust foundation of educational strategies is vital to ensure seamless integration into both medical education and collaborative medical practice.
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Affiliation(s)
- Olivia W. Thomas
- Director of Nutrition Innovation and Implementation, Boston Medical Center, Boston, MA, USA
| | - Jo Marie Reilly
- Professor of Clinical Family Medicine and Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nathan I. Wood
- Instructor of Medicine and Medical Education Fellow, Yale School of Medicine, New Haven, CT, USA
| | - Jaclyn Albin
- Combined Internal Medicine and Pediatrics Residency; Culinary Medicine Program, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Brennan BR, Beals KA, Burns RD, Chow CJ, Locke AB, Petzold MP, Dvorak TE. Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy. Nutrients 2023; 15:4157. [PMID: 37836442 PMCID: PMC10574678 DOI: 10.3390/nu15194157] [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: 08/25/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.
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Affiliation(s)
- Britta Retzlaff Brennan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Katherine A. Beals
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Ryan D. Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Candace J. Chow
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Amy B. Locke
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Margaret P. Petzold
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 84112, USA; (A.B.L.); (M.P.P.)
| | - Theresa E. Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA;
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Wood NI, Stone TA, Siler M, Goldstein M, Albin JL. Physician-Chef-Dietitian Partnerships for Evidence-Based Dietary Approaches to Tackling Chronic Disease: The Case for Culinary Medicine in Teaching Kitchens. J Healthc Leadersh 2023; 15:129-137. [PMID: 37520178 PMCID: PMC10378677 DOI: 10.2147/jhl.s389429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Since the middle of the 20th century, the American food environment has become increasingly ultra-processed. As a result, the prevalence of chronic, diet-related disease in the United States has skyrocketed. Meanwhile, physicians are still poorly trained in nutrition. A recent innovation that aims to address this is "culinary medicine" programming taught by teams of physicians, chefs, and registered dietitian nutritionists. Culinary medicine is an evidence-based, interprofessional field of medicine that combines culinary arts, nutrition science, and medical education to prevent and treat diet-related disease. It employs hands-on learning through healthy cooking and is typically taught in a teaching kitchen, either in-person or virtually. It can be dosed either as a patient care intervention or as experiential nutrition education for students, medical trainees, and healthcare professionals. Culinary medicine programs are effective, financially feasible, and well-received. As a result, healthcare systems and medical education programs are increasingly incorporating culinary medicine, teaching kitchens, and interprofessional nutrition education into their patient care and training models.
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Affiliation(s)
- Nathan I Wood
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Theresa A Stone
- Department of Internal Medicine, MedStar Health, Washington, DC, USA
| | - Milette Siler
- Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Fort Worth, TX, USA
| | - Max Goldstein
- Digestive Health Center, Yale New Haven Health, New Haven, CT, USA
| | - Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Albin JL, Siler M, Kitzman H. Culinary Medicine eConsults Pair Nutrition and Medicine: A Feasibility Pilot. Nutrients 2023; 15:2816. [PMID: 37375720 DOI: 10.3390/nu15122816] [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: 05/16/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
The global impact of diet-sensitive disease demands innovative nutrition education for health professionals and widespread, reimbursable clinical models to apply nutrition to practice. Interprofessional collaboration across disciplines and the optimization of emerging telemedicine consultation strategies, including electronic consultation (eConsult), merge to deliver vital innovation in the delivery of nutrition-based clinical care. Aligning with an existing eConsult infrastructure in the institutional electronic health record (EHR), a physician-dietitian team developed a novel Culinary Medicine eConsult. During a pilot phase, the service was introduced to primary care clinicians, and a response algorithm for eConsults was created. During the 12-month pilot phase, the Culinary Medicine team completed 25 eConsults from 11 unique primary care clinicians with a 76% (19/25) insurance reimbursement rate. Topics varied from dietary strategies for preventing and managing common metabolic diseases to specific dietary influences on microbiome health and disease flares. Requesting clinicians reported time saved in their clinic encounters and high patient satisfaction with expert nutrition guidance. EConsults in Culinary Medicine promote the integration of interprofessional nutrition care into existing clinical structures and empower enhanced access to the vital domain of dietary health. EConsults deliver timely answers to clinical questions and create opportunities for further innovation in care delivery as communities, health systems, and payors seek solutions to the growing burden of diet-sensitive diseases.
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Affiliation(s)
- Jaclyn L Albin
- University of Texas Southwestern Medical Center, School of Medicine, Departments of Internal Medicine and Pediatrics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute and the University of Texas Southwestern Medical Center, 400 W Magnolia Ave, Fort Worth, TX 76104, USA
| | - Heather Kitzman
- University of Texas Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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Asher RC, Clarke ED, Bucher T, Shrewsbury VA, Roberts S, Collins CE. Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption. J Hum Nutr Diet 2023; 36:967-980. [PMID: 36321462 PMCID: PMC10947242 DOI: 10.1111/jhn.13109] [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: 06/29/2022] [Accepted: 10/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality. METHODS A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures. RESULTS Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention. CONCLUSIONS The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.
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Affiliation(s)
- Roberta C. Asher
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Erin D. Clarke
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Tamara Bucher
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
- School of Environmental and Life Sciences, College of EngineeringScience and EnvironmentCallaghanAustralia
| | - Vanessa A. Shrewsbury
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | | | - Clare E. Collins
- School of Health Sciences, College of HealthMedicine and WellbeingCallaghanAustralia
- Food and Nutrition Research Program, Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
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Amoore BY, Gaa PK, Amalba A, Mogre V. Nutrition education intervention improves medical students' dietary habits and their competency and self-efficacy in providing nutrition care: A pre, post and follow-up quasi-experimental study. Front Nutr 2023; 10:1063316. [PMID: 36937356 PMCID: PMC10019772 DOI: 10.3389/fnut.2023.1063316] [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: 10/10/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Most doctors and medical students report inadequate competencies in nutrition care. We evaluated the impact of a nutrition education intervention on medical students' lifestyle habits, dietary diversity, nutrition care knowledge, attitude toward nutrition care, and their level of self-efficacy in the provision of nutrition care. Methods All 2nd-year medical students were enrolled into a 5 week, 24-h nutrition education intervention that involved both deductive and practical sessions. Pre-, post and 4 weeks follow-up assessments were conducted. Results At post- and 4-weeks post-intervention the number of days participants consumed vegetables and engaged in moderate-to-vigorous physical activity significantly (p = 0.003 and 0.002) improved respectively from baseline. Mean nutrition care knowledge scores of participants increased by 3.27 points (95% Cl: 1.98-4.56, p < 0.001) from 19.49 at baseline through to 24.78 post- and 22.76 4 weeks follow-up. No significant [X ( 2 ) 2 = 1.568, p = 0.457] change in mean attitude toward nutrition care score was recorded. Mean level of self-efficacy in the provision of nutrition care improved significantly by 1.73 (95% Cl: 1.17-2.28, p < 0.001) at post-intervention and 4 weeks follow-up compared to the baseline scores. Conclusion The intervention improved the nutrition care knowledge, self-efficacy in the provision of nutrition care as well as medical students' own consumption of vegetables, dietary diversity and their engagement in moderate-to-vigorous physical activity. However, continuous implementation of nutrition education interventions is needed to sustain these outcomes and further improve the nutrition education experience of medical students.
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Affiliation(s)
- Bright Yammaha Amoore
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Patience Kanyiri Gaa
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
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Razavi AC, Latoff A, Dyer A, Albin JL, Artz K, Babcock A, Cimino F, Daghigh F, Dollinger B, Fiellin M, Johnston EA, Jones GM, Karch RD, Keller ET, Nace H, Parekh NK, Petrosky SN, Robinson A, Rosen J, Sheridan EM, Warner SW, Willis JL, Harlan TS. Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees. BMJ Nutr Prev Health 2023; 6:6-13. [PMID: 37559965 PMCID: PMC10407392 DOI: 10.1136/bmjnph-2022-000477] [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: 04/18/2022] [Accepted: 12/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion. PURPOSE To determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and lifestyle medicine competencies among medical trainees across the USA. METHOD A total of 1433 medical trainees across 19 sites over a 12-month period were included. The Cooking for Health Optimisation with Patients-Medical Trainees survey composed of 61 questions regarding demographics, nutritional attitudes, dietary habits including MedDiet score and lifestyle medicine counselling competencies. Multivariable logistic regression assessed the association of virtual culinary medicine education with MedDiet intake and nutritional attitudes. RESULTS There were 519 medical trainees who participated in virtual culinary medicine education and 914 medical trainees who participated in their standard nutrition curricula. More than one-half of participants were women (n=759) and the mean age was 27 years old. Compared with students enrolled in traditional nutrition curricula, participants in virtual culinary medicine education were 37% more likely to adhere to MedDiet guidelines for fruit intake (OR 1.37, 95% CI 1.03 to 1.83, p=0.03). Virtual culinary medicine education was associated with higher proficiency in lifestyle medicine counselling categories, notably recommendations involving fibre (OR 4.03; 95% CI 3.05 to 5.34), type 2 diabetes prevention (OR 4.69; 95% CI 3.51 to 6.27) and omega fatty acids (OR 5.21; 95% CI 3.87 to 7.02). Virtual culinary medicine education had a similar, although higher magnitude association with MedDiet counselling competency (OR 5.73, 95% CI 4.26 to 7.70) when compared with historical data previously reported using hands-on, in-person culinary medicine courseware (OR 4.97, 95% CI 3.89 to 6.36). CONCLUSIONS Compared with traditional nutritional educational curricula, virtual culinary medicine education is associated with higher MedDiet adherence and lifestyle medicine counselling competencies among medical trainees. Both virtual and hands-on culinary medicine education may be useful for cardiovascular health promotion.
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Affiliation(s)
- Alexander C Razavi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Latoff
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Amber Dyer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | - Kristi Artz
- Spectrum Health, Grand Rapids, Michigan, USA
| | | | | | - Farzaneh Daghigh
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Beth Dollinger
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Maya Fiellin
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Emily A Johnston
- Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Grace Marie Jones
- Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Robert D Karch
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | | | - Heather Nace
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Amy Robinson
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Jessica Rosen
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Eva M Sheridan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Susan W Warner
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Timothy S Harlan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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12
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A scoping review of nutrition education interventions to improve competencies, lifestyle and dietary habits of medical students and residents. J Nutr Sci 2023; 12:e31. [PMID: 37008413 PMCID: PMC10052561 DOI: 10.1017/jns.2023.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Abstract
We reviewed the available research and gave an overview of the effects of nutrition education interventions (NEIs) on medical students’ and residents’ knowledge of nutrition, attitudes towards nutrition care, self-efficacy, dietary practices and readiness to offer nutrition care. From 28 May through 29 June 2021, we searched Google Scholar, PubMed, ProQuest, Cochrane and ProQuest to retrieve 1807 articles. After conducting de-duplication and applying the eligibility criteria and reviewing the title and abstract, 23 papers were included. The data were descriptively and narratively synthesised, and the results were displayed as frequencies, tables and figures. Twenty-one interventions were designed to increase participants’ knowledge of nutrition-related topics, and eighteen studies found that nutrition knowledge had significantly improved post-intervention. Only four of the eleven studies that reported on attitudes about nutrition post-intervention showed a meaningful improvement. The self-efficacy of participants was examined in more than half of the included studies (n 13, 56⋅5 %), and eleven of these studies found a significant increase in the participants’ level of self-efficacy to offer nutrition care post-intervention. At the post-intervention point, seven interventions found that dietary and lifestyle habits had significantly improved. The review demonstrated the potential of NEIs to enhance participants’ dietary habits and nutrition-related knowledge, attitudes and self-efficacy. Reduced nutrition knowledge, attitude and self-efficacy scores during the follow-up, point to the need for more opportunities for medical students and residents to learn about nutrition after the intervention.
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13
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Yousef NM, Wallace RJ, Harlan GA, Beale E. Bringing the "Joy of Healthy Eating" to Advanced Medical Students: Utilizing a Remote Learning Platform to Teach Culinary Medicine: Findings from the First Online Course Based on the ACLM's Whole-Food Plant-Based Culinary Medicine Curriculum. Am J Lifestyle Med 2022; 16:447-459. [PMID: 35860368 PMCID: PMC9290182 DOI: 10.1177/15598276221092971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2023] Open
Abstract
Over 80% of chronic disease is caused by lifestyle practices, including an unhealthy diet. Despite this, most medical students in the United States graduate having received minimal nutrition education, guidance towards improving their nutrition, or skills needed to coach patients to adopt a healthier diet. This study aimed to educate fourth-year medical students in evidence-based knowledge regarding a delicious, whole-food plant-based diet while introducing practical culinary skills and patient coaching skills. We adapted an open-source culinary medicine curriculum designed for in-person teaching of pre-clinical medical students to provide a novel 1-month online elective to fourth-year medical students. We used a 26-item pre/post questionnaire to assess change in evidence-based knowledge regarding nutrition, culinary skills, patient coaching skills, and attitudes toward a whole-food plant-based diet. In addition, we reviewed narrative comments by the student participants, course directors, and medical-school administrators. Scores in all 4 domains were tested, and for all individual questions, they showed statistically significant improvement following the course. Most narrative responses were positive, and areas for improvement were also identified. We successfully adapted an open-source whole-food plant-based culinary medicine curriculum for advanced medical students into a 1-month elective taught on a virtual platform. This course filled a need for training in nutrition and counseling for these students as they start their professional careers.
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Affiliation(s)
- Natalie M. Yousef
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Robert J. Wallace
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Gregory A. Harlan
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Beale
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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14
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Tan J, Atamanchuk L, Rao T, Sato K, Crowley J, Ball L. Exploring culinary medicine as a promising method of nutritional education in medical school: a scoping review. BMC MEDICAL EDUCATION 2022; 22:441. [PMID: 35672843 PMCID: PMC9175378 DOI: 10.1186/s12909-022-03449-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/10/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dietary modifications are considered a first-line intervention for chronic disease management, yet graduating doctors still report not feeling competent to counsel patients on their diet. Research has focused on methods to address this shortfall in physician competency, including culinary medicine. Culinary medicine is an approach to education that involves hands-on food and cooking learning experiences to equip participants with tools for improving the nutrition behaviour and health of their future patients. Despite positive findings in the efficacy of these interventions, they differ markedly in approach and target, which therefore fails to provide adequate evidence that could serve to guide future culinary medicine interventions. OBJECTIVE A scoping review to synthesize the existing literature on culinary medicine interventions that are offered during medical training. METHODS Online databases were used to identify literature published prior to April 2022 that involve a hands-on culinary medicine component to nutrition and examine academic impact, feasibility and acceptability. RESULTS Twenty-four studies met the eligibility criteria. Despite promising gains in nutrition knowledge, confidence and high acceptability of the programs, large variations exist in delivery method, setting, and course content between programs. There is a lack of program cost reporting and long-term follow up of participants, inconsistent evidence for improved nutrition attitudes amongst participants, as well as geographically limited adoption of such programs. CONCLUSIONS The findings of this research demonstrate a clear increase in interest in the use of hands-on culinary medicine programs as educational tools, evidence of feasibility in implementation, and improved student nutritional knowledge, skill and counseling compared to a traditional didactic curriculum. The quality of culinary medicine research studies is increasing and the aims of research are narrowing to focus on how culinary medicine can positively impact medical education. The findings from this review will aid in legitimising culinary medicine as an effective delivery method of nutritional education in medical programs.
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Affiliation(s)
| | | | - Tanish Rao
- Griffith University, Gold Coast, Australia
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15
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Thomason N, Monlezun DJ, Javaid A, Filipescu A, Koutroumpakis E, Shobayo F, Kim P, Lopez-Mattei J, Cilingiroglu M, Iliescu G, Marmagkiolis K, Ramirez PT, Iliescu C. Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients. Front Cardiovasc Med 2022; 8:793877. [PMID: 35237670 PMCID: PMC8882615 DOI: 10.3389/fcvm.2021.793877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BackgroundDespite the growing number of patients with both coronary artery disease and gynecological cancer, there are no nationally representative studies of mortality and cost effectiveness for percutaneous coronary interventions (PCI) and this cancer type.MethodsBackward propagation neural network machine learning supported and propensity score adjusted multivariable regression was conducted for the above outcomes in this case-control study of the 2016 National Inpatient Sample (NIS), the United States' largest all-payer hospitalized dataset. Regression models were fully adjusted for age, race, income, geographic region, cancer metastases, mortality risk, and the likelihood of undergoing PCI (and also with length of stay [LOS] for cost). Analyses were also adjusted for the complex survey design to produce nationally representative estimates. Centers for Disease Control and Prevention (CDC)-based cost effectiveness ratio (CER) analysis was performed.ResultsOf the 30,195,722 hospitalized patients meeting criteria, 1.27% had gynecological cancer of whom 0.02% underwent PCI including 0.04% with metastases. In propensity score adjusted regression among all patients, the interaction of PCI and gynecological cancer (vs. not having PCI) significantly reduced mortality (OR 0.53, 95%CI 0.36–0.77; p = 0.001) while increasing LOS (Beta 1.16 days, 95%CI 0.57–1.75; p < 0.001) and total cost (Beta $31,035.46, 95%CI 26758.86–35312.06; p < 0.001). Among gynecological cancer patients, mortality was significantly reduced by PCI (OR 0.58, 95%CI 0.39–0.85; p = 0.006) and being in East North Central, West North Central, South Atlantic, and Mountain regions (all p < 0.03) compared to New England. PCI reduced mortality but not significantly for metastatic patients (OR 0.74, 95%CI 0.32–1.71; p = 0.481). Eighteen extra gynecological cancer patients' lives were saved with PCI for a net national cost of $3.18 billion and a CER of $176.50 million per averted death.ConclusionThis large propensity score analysis suggests that PCI may cost inefficiently reduce mortality for gynecological cancer patients, amid income and geographic disparities in outcomes.
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Affiliation(s)
- Nicole Thomason
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Dominique J. Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
- Center for Artificial Intelligence & Health Equities, Global System Analytics & Structures, New Orleans, LA, United States
| | - Awad Javaid
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, United States
| | - Alexandru Filipescu
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Efstratios Koutroumpakis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Fisayomi Shobayo
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, United States
| | - Gloria Iliescu
- Department of Internal Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Kostas Marmagkiolis
- Division of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Pedro T. Ramirez
- Department of GynOnc and Reproductive Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Cezar Iliescu
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16
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Patel P, Kassam S. Evaluating nutrition education interventions for medical students: A rapid review. J Hum Nutr Diet 2021; 35:861-871. [PMID: 34842308 PMCID: PMC9546301 DOI: 10.1111/jhn.12972] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/09/2023]
Abstract
Background Unhealthy diets account for 20% of all deaths globally. Most medical schools do not sufficiently teach their students the clinical application of nutrition science. Evaluating the efficacy of nutrition education interventions is therefore important for their widespread implementation. Methods A rapid review of the literature published between 2015 and 2020 was conducted to identify nutrition education interventions delivered to undergraduate medical students. The modified Kirkpatrick hierarchy score was used to evaluate the outcome measures. Study characteristics and outcomes were charted and discussed using narrative synthesis. Included studies were appraised using the MERSQI criteria. Results Fifteen nutrition education interventions met the inclusion criteria. Twelve were from the USA and most were optional rather than compulsory. Interventions involved a mixture of methods including cooking sessions, lectures, and student‐led programs. The content covered was variable and the median duration was 11 h (range 90 min to 75 h). The modified Kirkpatrick scores varied and the median MERSQI score was 12.8/18. No studies reported the use of national or standardised guidance to inform the learning objectives of the interventions. Conclusions The interventions reviewed are heterogenous in their nature and outcomes. This review highlights the advantages of utilising interprofessional learning, focusing on student's personal health behaviours and harnessing novel teaching methods such as hands‐on cooking. Using national guidance to develop learning outcomes will help to standardise the content taught. Future studies may aim to use validated assessment tools and investigate the long‐term impacts on delivery of care and patient outcomes. Increased nutrition training in medical education is needed. A variety of teaching approaches were identified, including novel methods such as culinary medicine and service learning. Future research is needed to further evaluate nutrition education interventions, including patient health outcomes. Development and utilisation of national guidance is needed to standardise content.
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Affiliation(s)
- Priya Patel
- College of Medicine and Health, St Luke's Campus, University of Exeter, Exeter, UK
| | - Shireen Kassam
- Department of Haematology, Kings College Hospital, Denmark Hill, London.,Faculty of Health and Wellbeing, University of Winchester, Winchester, Hampshire
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17
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Hussain YK, Shoaib H, Ramjan F, Makan HS, Khapedi AF, Ali MS. Incorporating nutrition competencies into medical education. JPEN J Parenter Enteral Nutr 2021; 45:1616-1617. [DOI: 10.1002/jpen.2244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Haris Shoaib
- GKT School of Medical Education King's College London London UK
| | - Faeez Ramjan
- GKT School of Medical Education King's College London London UK
| | | | - Asif F. Khapedi
- GKT School of Medical Education King's College London London UK
| | - Muhammad S. Ali
- GKT School of Medical Education King's College London London UK
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18
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Asher RC, Shrewsbury VA, Bucher T, Collins CE. Culinary medicine and culinary nutrition education for individuals with the capacity to influence health related behaviour change: A scoping review. J Hum Nutr Diet 2021; 35:388-395. [PMID: 34415642 DOI: 10.1111/jhn.12944] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Culinary medicine (CM) or culinary nutrition (CN) education provided to professionals with the capacity to influence behaviour change is an emerging strategy to promote diet quality and reduce the burden of diet related chronic disease in adults. The purpose of this scoping review was to synthesise current research describing CM/CN education provided to or by health, education and culinary professionals, or students of these disciplines. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was used. Eleven electronic databases were searched in March 2019. Included studies were: (i) nutrition, health or lifestyle programs with a CM/CN component; (ii) study participants or programs facilitated by people working or training in health, community and/or adult education, or culinary roles where facilitator training was described; (iii) reported in the English language; and (iv) published from 2003. RESULTS In total, 33 studies were included. Nineteen studies delivered programs to general population groups and were facilitated by health professionals and/or health university students. Fourteen studies delivered CM/CN training to health professionals or students. Studies reported changes in participants' culinary skill and nutrition knowledge (n = 18), changes in dietary intake (n = 13), attitudes and behaviour change in healthy eating and cooking (n = 4), and competency in nutrition counselling and knowledge (n = 7). CONCLUSIONS Further research examining the effectiveness of CM/CN programs, and that describes optimal content, format and timing of the programs, is needed. Research evaluating the impact of training in CM/CN to education and culinary professionals on healthy cooking behaviours of their patients/clients is warranted.
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Affiliation(s)
- Roberta C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, USA.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, USA.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Tamara Bucher
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia.,School of Environmental and Life Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, USA
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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19
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Monlezun DJ, Hostetter L, Balan P, Palaskas N, Lopez-Mattei J, Cilingiroglu M, Iakobishvili Z, Ewer M, Marmagkiolis K, Iliescu C. TAVR and cancer: machine learning-augmented propensity score mortality and cost analysis in over 30 million patients. CARDIO-ONCOLOGY 2021; 7:25. [PMID: 34183072 PMCID: PMC8237429 DOI: 10.1186/s40959-021-00111-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/03/2021] [Indexed: 01/14/2023]
Abstract
Introduction Cardiovascular disease (CVD) and cancer are the top mortality causes globally, yet little is known about how the diagnosis of cancer affects treatment options in patients with hemodynamically compromising aortic stenosis (AS). Patients with cancer often are excluded from aortic valve replacement (AVR) trials including trials with transcatheter AVR (TAVR) and surgical AVR (SAVR). This study looks at how cancer may influence treatment options and assesses the outcome of patients with cancer who undergo SAVR or TAVR intervention. Additionally, we sought to quantitate and compare both clinical and cost outcomes for patients with and without cancer. Methods This population-based case-control study uses the most recent year available National Inpatient Sample (NIS (2016) from the United States Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). Machine learning augmented propensity score adjusted multivariable regression was conducted based on the likelihood of undergoing TAVR versus medical management (MM) and TAVR versus SAVR with model optimization supported by backward propagation neural network machine learning. Results Of the 30,195,722 total hospital admissions, 39,254 (0.13%) TAVRs were performed, with significantly fewer performed in patients with versus without cancer even in those of comparable age and mortality risk (23.82% versus 76.18%, p < 0.001) despite having similar hospital and procedural mortality. Multivariable regression in patients with cancer demonstrated that mortality was similar for TAVR, MM, and SAVR, though LOS and cost was significantly lower for TAVR versus MM and comparable for TAVR versus SAVR. Patients with prostate cancer constituted the largest primary cancer among TAVR patients including those with metastatic disease. There were no significant race or geographic disparities for TAVR mortality. Discussion Comparison of aortic valve intervention in patients with and without cancer suggests that interventions are underutilized in the cancer population. This study suggests that patients with cancer including those with metastasis have similar inpatient outcomes to patients without cancer. Further, patients who have symptomatic AS and those with higher risk aortic valve disease should be offered the benefit of intervention. Modern techniques have reduced intervention-related adverse events, provided improved quality of life, and appear to be cost effective; these advantages should not necessarily be denied to patients with co-existing cancer.
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Affiliation(s)
- Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA. .,Global System Analytics & Structures, New Orleans, USA.
| | - Logan Hostetter
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Prakash Balan
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA
| | - Mehmet Cilingiroglu
- Division of Cardiovascular Disease, University of Hawaii John Burns School of Medicine, Honolulu, HI, USA
| | - Zaza Iakobishvili
- Department of Community Cardiology, Tel Aviv University, Tel Aviv, Israel
| | - Michael Ewer
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA
| | - Konstantinos Marmagkiolis
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA
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20
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Meta-analysis and machine learning-augmented mixed effects cohort analysis of improved diets among 5847 medical trainees, providers and patients. Public Health Nutr 2021; 25:281-289. [PMID: 34176552 PMCID: PMC8883775 DOI: 10.1017/s1368980021002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition. Design: (Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world’s largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients. Settings: (A) Medical educational institutions. (B) Teaching kitchens. Participants: (A) Medical trainees. (B) Trainees, providers and patients. Results: (A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML. Conclusions: The current study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.
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21
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Monlezun DJ, Lawless S, Palaskas N, Peerbhai S, Charitakis K, Marmagkiolis K, Lopez-Mattei J, Mamas M, Iliescu C. Machine Learning-Augmented Propensity Score Analysis of Percutaneous Coronary Intervention in Over 30 Million Cancer and Non-cancer Patients. Front Cardiovasc Med 2021; 8:620857. [PMID: 33889598 PMCID: PMC8055825 DOI: 10.3389/fcvm.2021.620857] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is unknown to what extent the clinical benefits of PCI outweigh the risks and costs in patients with vs. without cancer and within each cancer type. We performed the first known nationally representative propensity score analysis of PCI mortality and cost among all eligible adult inpatients by cancer and its types. Methods: This multicenter case-control study used machine learning–augmented propensity score–adjusted multivariable regression to assess the above outcomes and disparities using the 2016 nationally representative National Inpatient Sample. Results: Of the 30,195,722 hospitalized patients, 15.43% had a malignancy, 3.84% underwent an inpatient PCI (of whom 11.07% had cancer and 0.07% had metastases), and 2.19% died inpatient. In fully adjusted analyses, PCI vs. medical management significantly reduced mortality for patients overall (among all adult inpatients regardless of cancer status) and specifically for cancer patients (OR 0.82, 95% CI 0.75–0.89; p < 0.001), mainly driven by active vs. prior malignancy, head and neck and hematological malignancies. PCI also significantly reduced cancer patients' total hospitalization costs (beta USD$ −8,668.94, 95% CI −9,553.59 to −7,784.28; p < 0.001) independent of length of stay. There were no significant income or disparities among PCI subjects. Conclusions: Our study suggests among all eligible adult inpatients, PCI does not increase mortality or cost for cancer patients, while there may be particular benefit by cancer type. The presence or history of cancer should not preclude these patients from indicated cardiovascular care.
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Affiliation(s)
- Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sean Lawless
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shareez Peerbhai
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Konstantinos Charitakis
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | | | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Department of Cardiology, Royal Stroke Hospital Stoke on Trent, Stoke-on-Trent, United Kingdom
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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22
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Baker S, Monlezun DJ, Wieghard N, Whitlow C, Margolin D. Are the current colonoscopy recommendations for interval surveillance in patients with polyps enough? Machine learning-augmented propensity score cohort analysis of 1840 patients. Surg Endosc 2021; 36:1284-1292. [PMID: 33763746 DOI: 10.1007/s00464-021-08403-3] [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: 04/16/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Colonoscopy remains the gold standard for screening and surveillance of colorectal neoplasms, and is associated with a lower risk of colorectal cancer (CRC)-related mortality. The current interval surveillance recommendations in patients with previous adenomas lack sufficient evidence. The prevalence of subsequent adenomas, and especially high-risk adenomas, during surveillance is not well known. METHODS The primary outcome of this study was to determine the prevalence of polyps upon surveillance colonoscopy in patients who have a history of adenomas on initial average-risk-screening colonoscopy, but then have a normal initial surveillance (second) colonoscopy between 2003 and 2017. This is the first known retrospective cohort study of adenoma detection rate (ADR) with sub-group analysis of patients with serial surveillance colonoscopies by abnormal and high-risk surveillance findings separately by prior abnormal colonoscopies and correct surveillance strategies based on the recent March 2020 updated guidelines. After ADR calculation, machine learning-augmented propensity score adjusted multivariable regression with augmented inverse-probability weighting propensity (AIPW) score analysis was used to assess the relationship between guideline adherence, as well as abnormal and high-risk surveillance findings. RESULTS A total of 1840 patients with pathologically confirmed adenomas or cancer on an initial average-risk-screening (first) colonoscopy met study criteria. 837 (45.5%) had confirmed adenomas on second colonoscopy, and 1003 (54.5%) had normal findings. Of 837 patients with polyps on both first and second colonoscopy, 423 (50.5%) had adenomas on third colonoscopy. Of the 1003 patients without polyps on second colonoscopy, 406 (40.5%) had confirmed adenomas on third colonoscopy. Guideline adherence was low at 9.18%, though was associated in propensity score adjusted multivariable regression with increased odds of an abnormal third (but not high-risk) colonoscopy, with comparable AIPW results. CONCLUSION This 14-year study demonstrates the ADR to be > 40% on the third colonoscopy for patients with adenomas on initial screening colonoscopy, who then have a normal second colonoscopy. Through advanced machine learning and propensity score analysis, we showed that correct adherence is associated with higher odds of abnormal, but not high-risk abnormal 3rd colonoscopy, with evidence that high-risk surveillance findings are reduced by providers shortening the time between surveillance colonoscopies in contrast to the guidelines for those for whom there is presumed greater clinical suspicion of eventual cancer. Larger prospective trials are needed to guide optimal surveillance for these patients.
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Affiliation(s)
- Sarah Baker
- Department of Colorectal Surgery, Ochsner Clinic, New Orleans, LA, USA.
| | - Dominique J Monlezun
- Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Global System Analytics & Structures, New Orleans, LA, USA
| | - Nicole Wieghard
- Department of Colorectal Surgery, Ochsner Clinic, New Orleans, LA, USA
| | - Charles Whitlow
- Department of Colorectal Surgery, Ochsner Clinic, New Orleans, LA, USA
| | - David Margolin
- Department of Colorectal Surgery, Ochsner Clinic, New Orleans, LA, USA
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23
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Goyal RK, Dawson CA, Epstein SB, Brach RJ, Finnie SM, Lounsbury KM, Lahey T, Eldakar-Hein ST. The design and implementation of a longitudinal social medicine curriculum at the University of Vermont's Larner College of Medicine. BMC MEDICAL EDUCATION 2021; 21:131. [PMID: 33627097 PMCID: PMC7903930 DOI: 10.1186/s12909-021-02533-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite an abundant literature advocating that social determinants of health (SDH) be taught during undergraduate medical education, there are few detailed descriptions of how to design and implement longitudinal core curricula that is delivered to all students and accomplishes this goal. METHODS In this paper, we describe the design and implementation of a social medicine curriculum at the University of Vermont's Larner College of Medicine (UVM Larner). Using Kern's principles, we designed a longitudinal curriculum that extends through both preclinical and clinical training for all students and focused on integrating SDH material directly into basic science and clinical training. RESULTS We successfully developed and implemented two primary tools, a "Social Medicine Theme of the Week" (SMTW) in preclinical training, and SDH rounds in the clinical setting to deliver SDH content to all learners at UVM Larner. CONCLUSIONS Extensive student-faculty partnerships, robust needs assessment, and focusing on longitudinal and integrated SDH content delivery to all students were key features that contributed to successful design and implementation.
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Affiliation(s)
- Raghav K Goyal
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Christina A Dawson
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Samuel B Epstein
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Richard J Brach
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Sheridan M Finnie
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Karen M Lounsbury
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Timothy Lahey
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA.
| | - Shaden T Eldakar-Hein
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
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24
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Baker SE, Monlezun DJ, Ambroze WL, Margolin DA. Anastomotic Leak is Increased With Clostridium difficile Infection After Colectomy: Machine Learning-Augmented Propensity Score Modified Analysis of 46 735 Patients. Am Surg 2020; 88:74-82. [PMID: 33356437 DOI: 10.1177/0003134820973720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is now the most common cause of healthcare-associated infections, with increasing prevalence, severity, and mortality of nosocomial and community-acquired CDI which makes up approximately one third of all CDI. There are also increased rates of asymptomatic colonization particularly in high-risk patients. C difficile is a known collagenase-producing bacteria which may contribute to anastomotic leak (AL). METHODS Machine learning-augmented multivariable regression and propensity score (PS)-modified analysis was performed in this nationally representative case-control study of CDI and anastomotic leak, mortality, and length of stay for colectomy patients using the ACS-NSQIP database. RESULTS Among 46 735 colectomy patients meeting study criteria, mean age was 61.7 years (SD 14.38), 52.2% were woman, 72.5% were Caucasian, 1.5% developed CDI, 3.1% developed anastomotic leak, and 1.6% died. In machine learning (backward propagation neural network)-augmented multivariable regression, CDI significantly increases anastomotic leak (OR 2.39, 95% CI 1.70-3.36; P < .001), which is similar to the neural network results. Having CDI increased the independent likelihood of anastomotic leak by 3.8% to 6.8% overall, and in dose-dependent fashion with increasing ASA class to 4.3%, 5.7%, 7.6%, and 10.0%, respectively, for ASA class I to IV. In doubly robust augmented inverse probability weighted PS analysis, CDI significantly increases the likelihood of AL by 4.58% (95% CI 2.10-7.06; P < .001). CONCLUSIONS This is the first known nationally representative study on CDI and AL, mortality, and length of stay among colectomy patients. Using advanced machine learning and PS analysis, we provide evidence that suggests CDI increases AL in a dose-dependent manner with increasing ASA Class.
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Affiliation(s)
- Sarah E Baker
- Department of Colorectal Surgery, 5786Ochsner Clinic, LA, USA.,Georgia Colon & Rectal Surgical Associates, Northside Hospital, GA, USA
| | | | - Wayne L Ambroze
- Georgia Colon & Rectal Surgical Associates, Northside Hospital, GA, USA
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25
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Razavi AC, Dyer A, Jones M, Sapin A, Caraballo G, Nace H, Dotson K, Razavi MA, Harlan TS. Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education. Nutrients 2020; 12:E3632. [PMID: 33255901 PMCID: PMC7761274 DOI: 10.3390/nu12123632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.
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Affiliation(s)
- Alexander C. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Matthew Jones
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Graciela Caraballo
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Heather Nace
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Kerri Dotson
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Michael A. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Timothy S. Harlan
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
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26
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Effect of culinary education curriculum on Mediterranean diet adherence and food cost savings in families: a randomised controlled trial. Public Health Nutr 2020; 24:2297-2303. [PMID: 32744215 DOI: 10.1017/s1368980020002256] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diet-related diseases are the leading cause of morbidity and mortality in the USA. While the critical aspects of a healthy diet are well known, the relationship between community-based, teaching kitchen education and dietary behaviours is unclear. We examined the effect of a novel culinary medicine education programme on Mediterranean diet adherence and food cost savings. DESIGN Families were randomised to a hands-on, teaching kitchen culinary education class (n = 18) or non-kitchen-based dietary counselling (n = 23) for 6 weeks. The primary outcome was adherence to the validated nine-point Mediterranean diet score, and the secondary outcome was food cost savings per family. SETTING The Goldring Center for Culinary Medicine, a community teaching kitchen in New Orleans. PARTICIPANTS Families (n = 41) of at least one child and one parent. RESULTS Compared with families receiving traditional dietary counselling, those participating in hands-on, kitchen-based nutrition education were nearly three times as likely to follow a Mediterranean dietary pattern (OR 2·93, 95% CI 1·73, 4·95; P < 0·001), experiencing a 0·43-point increase in Mediterranean diet adherence after 6 weeks (B = 0·43; P < 0·001). Kitchen-based nutrition education projects to save families $US 21·70 per week compared with standard dietary counselling by increasing the likelihood of consuming home-prepared v. commercially-prepared meals (OR 1·56, 95% CI 1·08, 2·25; P = 0·018). CONCLUSIONS Community-based culinary medicine education improves Mediterranean diet adherence and associates with food cost savings among a diverse sample of families. Hands-on culinary medicine education may be a novel evidence-based tool to teach healthful dietary habits and prevent chronic disease.
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27
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Rothman JM, Bilici N, Mergler B, Schumacher R, Mataraza-Desmond T, Booth M, Olshan M, Bailey M, Mascarenhas M, Duffy W, Virudachalam S, DeLisser HM. A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study. J Altern Complement Med 2020; 26:636-644. [DOI: 10.1089/acm.2020.0063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joshua M. Rothman
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Bilici
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Blake Mergler
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Schumacher
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maddy Booth
- Vetri Community Partnership, Philadelphia, PA, USA
| | | | - Melissa Bailey
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Mascarenhas
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William Duffy
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Horace M. DeLisser
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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28
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Razavi AC, Monlezun DJ, Sapin A, Sarris L, Schlag E, Dyer A, Harlan T. Etiological Role of Diet in 30-Day Readmissions for Heart Failure: Implications for Reducing Heart Failure-Associated Costs via Culinary Medicine. Am J Lifestyle Med 2020; 14:351-360. [PMID: 33281513 PMCID: PMC7692009 DOI: 10.1177/1559827619861933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background. Reducing the under-30-day readmission for heart failure (HF) patients is a modifiable quality-of-care measure, yet the role of diet in HF readmissions and cost-effective HF care remain ill-defined. Methods. Medical chart review was conducted to determine cause(s) for HF treatment failure. Randomized controlled trial-backed machine learning models were employed to assess the relationship of culinary medicine education with HF 30-day readmission rate and cost. Results. Of 1031 HF admissions, 130 occurred within 30 days of discharge (12.61%.) Nearly two-thirds of individuals were male (64.02%), while the mean age and median length of stay were 64.33 ± 14.02 and 2, respectively. Medication noncompliance (34.62%) was the most common etiology for 30-day readmissions, followed by dietary noncompliance (16.92%), comorbidity (16.92%), a combination of dietary and medication noncompliance (10%), HF exacerbation (10%), iatrogenic (10%), and drug abuse (1.54%). Medication noncompliance contributed to the highest gross charge by readmission, costing a total of $1 802 096. Compared with traditional care, culinary medicine education for HF patients would prevent 93 HF readmissions and save $3.9 million in an estimated 4-year period. Conclusion. Though pharmacological treatment remains a focal point of HF management, diet-based approaches may improve tertiary HF prevention and reduce HF-associated health care expenditures.
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Affiliation(s)
- Alexander C. Razavi
- Alexander C. Razavi, Tulane University
School of Public Health and Tropical Medicine, New Orleans, LA 70112, e-mail:
| | | | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane
University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD,
TH)
- Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES)
- University of Texas M.D. Anderson Cancer Center,
Houston, Texas (DJM)
| | - Leah Sarris
- Goldring Center for Culinary Medicine, Tulane
University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD,
TH)
- Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES)
- University of Texas M.D. Anderson Cancer Center,
Houston, Texas (DJM)
| | - Emily Schlag
- Goldring Center for Culinary Medicine, Tulane
University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD,
TH)
- Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES)
- University of Texas M.D. Anderson Cancer Center,
Houston, Texas (DJM)
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane
University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD,
TH)
- Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES)
- University of Texas M.D. Anderson Cancer Center,
Houston, Texas (DJM)
| | - Timothy Harlan
- Goldring Center for Culinary Medicine, Tulane
University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD,
TH)
- Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES)
- University of Texas M.D. Anderson Cancer Center,
Houston, Texas (DJM)
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29
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Patnaik A, Tran J, McWhorter JW, Burks H, Ngo A, Nguyen TD, Mody A, Moore L, Hoelscher DM, Dyer A, Sarris L, Harlan T, Chassay CM, Monlezun D. Regional variations in medical trainee diet and nutrition counseling competencies: Machine learning-augmented propensity score analysis of a prospective multi-site cohort study. MEDICAL SCIENCE EDUCATOR 2020; 30:911-915. [PMID: 34457749 PMCID: PMC8368255 DOI: 10.1007/s40670-020-00973-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Medical professionals and students are inadequately trained to respond to rising global obesity and nutrition-related chronic disease epidemics, primarily focusing on cardiovascular disease. Yet, there are no multi-site studies testing evidence-based nutrition education for medical students in preventive cardiology, let alone establishing student dietary and competency patterns. METHODS Cooking for Health Optimization with Patients (CHOP; NIH NCT03443635) was the first multi-national cohort study using hands-on cooking and nutrition education as preventive cardiology, monitoring and improving student diets and competencies in patient nutrition education. Propensity-score adjusted multivariable regression was augmented by 43 supervised machine learning algorithms to assess students outcomes from UT Health versus the remaining study sites. RESULTS 3,248 medical trainees from 20 medical centers and colleges met study criteria from 1 August 2012 to 31 December 2017 with 60 (1.49%) being from UTHealth. Compared to the other study sites, trainees from UTHealth were more likely to consume vegetables daily (OR 1.82, 95%CI 1.04-3.17, p=0.035), strongly agree that nutrition assessment should be routine clinical practice (OR 2.43, 95%CI 1.45-4.05, p=0.001), and that providers can improve patients' health with nutrition education (OR 1.73, 95%CI 1.03-2.91, p=0.038). UTHealth trainees were more likely to have mastered 12 of the 25 competency topics, with the top three being moderate alcohol intake (OR 1.74, 95%CI 0.97-3.11, p=0.062), dietary fats (OR 1.26, 95%CI 0.57-2.80, p=0.568), and calories (OR 1.26, 95%CI 0.70-2.28, p=0.446). CONCLUSION This machine learning-augmented causal inference analysis provides the first results that compare medical students nationally in their diets and competencies in nutrition education, highlighting the results from UTHealth. Additional studies are required to determine which factors in the hands-on cooking and nutrition curriculum for UTHealth and other sites produce optimal student - and, eventually, preventive cardiology - outcomes when they educate patients in those classes.
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Affiliation(s)
- Anish Patnaik
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Justin Tran
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - John W. McWhorter
- School of Public Health, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
- Michael & Susan Dell Center for Healthy Living, Austin, TX USA
| | - Helen Burks
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Alexandra Ngo
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Tu Dan Nguyen
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Avni Mody
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Laura Moore
- School of Public Health, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
- Michael & Susan Dell Center for Healthy Living, Austin, TX USA
| | - Deanna M. Hoelscher
- School of Public Health, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
- Michael & Susan Dell Center for Healthy Living, Austin, TX USA
| | - Amber Dyer
- The Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Leah Sarris
- The Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Timothy Harlan
- The Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - C Mark Chassay
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
| | - Dominique Monlezun
- McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, TX USA
- The Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA USA
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30
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Razavi AC, Monlezun DJ, Sapin A, Stauber Z, Schradle K, Schlag E, Dyer A, Gagen B, McCormack IG, Akhiwu O, Sarris L, Dotson K, Harlan TS. Multisite Culinary Medicine Curriculum Is Associated With Cardioprotective Dietary Patterns and Lifestyle Medicine Competencies Among Medical Trainees. Am J Lifestyle Med 2020; 14:225-233. [PMID: 32231488 DOI: 10.1177/1559827619901104] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background. Adherence to Mediterranean dietary patterns reduces the incidence of cardiovascular disease and other major chronic diseases. We aimed to assess the association between participation in kitchen-based nutrition education and Mediterranean diet intake and lifestyle medicine counseling competencies among medical trainees. Methods. The Cooking for Health Optimization with Patients (CHOP) curriculum is a hands-on cooking-based nutrition education program implemented at 32 medical programs (4125 medical trainees) across the United States. Mediterranean diet intake, nutrition attitudes, and lifestyle medicine counseling competencies were assessed via validated surveys. Multivariable-adjusted logistic regression assessed the relationship of CHOP education with Mediterranean diet intake, nutrition attitudes, and lifestyle medicine counseling competencies. Results. Individuals participating in the CHOP program were 82% more likely to follow the Mediterranean diet compared with those receiving traditional nutrition education (OR = 1.82; P < .001). CHOP participants were more likely to satisfy daily intake of fruits (OR = 1.33; P = .019) and vegetables (OR = 2.06; P < .001) and agree that nutrition counseling should be a routine component of clinical care (OR = 2.43; P < .001). Kitchen-based nutrition education versus traditional curricula is associated with a higher likelihood of total counseling competency involving 25 lifestyle medicine categories (OR = 1.67; P < .001). Conclusion. Kitchen-based nutrition education is associated with cardioprotective dietary patterns and lifestyle medicine counseling among medical trainees.
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Affiliation(s)
- Alexander C Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Dominique J Monlezun
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Zachary Stauber
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Kara Schradle
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Emily Schlag
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Brennan Gagen
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Isabella G McCormack
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Ofure Akhiwu
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Leah Sarris
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Kerri Dotson
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
| | - Timothy S Harlan
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, USA.,Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.,Philadelphia College of Osteopathic Medicine, Philadelphia, USA.,University of Texas School of Public Health, Houston, USA.,Ohio State University College of Medicine, Columbus, USA
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31
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Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health 2019; 3:e379-e389. [PMID: 31538623 DOI: 10.1016/s2542-5196(19)30171-8] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In many countries, doctors are recommended to provide nutrition care to patients to improve the dietary behaviours of individuals and populations. Here, we present a systematic review that aims to critically synthesise literature on nutrition education provided to medical students. METHODS In this systematic review, a literature search was done between May 1 and July 1, 2018, for articles on medical students' nutrition knowledge, skills, and confidence to counsel patients, from Nov 1, 2012, to Dec 31, 2018. Search terms related to medical students included "nutrition in medical education", "medical nutrition education", and "undergraduate medical nutrition education". Search terms for topic of interest included "nutrition", "knowledge", "skills", "nutrition counselling", "confidence", "nutrition care", or "nutrition education". Included studies examined any aspect of recently graduated (ie, ≤4 years) or current medical students' nutrition knowledge, attitudes, skills, or confidence (or all three) in nutrition or nutrition counselling; evaluated nutrition curriculum initiatives for medical students; or assessed recently graduated or current medical students' perceptions of nutrition education. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. Curriculum initiatives were also appraised. FINDINGS 66 studies were identified by the search and 24 were eligible for full-text analysis. 16 quantitative studies, three qualitative studies, and five curriculum initiatives from the USA (n=11), Europe (n=4), the Middle East (n=1), Africa (n=1), and Australasia (n=7) met the inclusion criteria. Our analysis of these studies showed that nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education. Deficits in nutrition education affect students' knowledge, skills, and confidence to implement nutrition care into patient care. A modest positive effect was reported from curriculum initiatives. INTERPRETATION Despite the centrality of nutrition to healthy lifestyle, medical students are not supported to provide high-quality, effective nutrition care. Medical education can be enhanced by institutional commitment to make nutrition education compulsory in medical training, establishment of nutrition competencies to provide a benchmark for nutrition knowledge and skills to be included in curricula, and supported by funding for innovative curriculum initiatives. These initiatives will improve nutrition in medical training to support future doctors for the 21st century. FUNDING Sir John Logan Campbell Medical Fellowship 2017, and an Australian National Health and Medical Research Council Fellowship.
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Affiliation(s)
- Jennifer Crowley
- Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Gerrit Jan Hiddink
- Strategic Communication Chair Group, Wageningen University, Wageningen, Netherlands
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Cahan EM, Hernandez-Boussard T, Thadaney-Israni S, Rubin DL. Putting the data before the algorithm in big data addressing personalized healthcare. NPJ Digit Med 2019; 2:78. [PMID: 31453373 PMCID: PMC6700078 DOI: 10.1038/s41746-019-0157-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/17/2019] [Indexed: 01/11/2023] Open
Abstract
Technologies leveraging big data, including predictive algorithms and machine learning, are playing an increasingly important role in the delivery of healthcare. However, evidence indicates that such algorithms have the potential to worsen disparities currently intrinsic to the contemporary healthcare system, including racial biases. Blame for these deficiencies has often been placed on the algorithm-but the underlying training data bears greater responsibility for these errors, as biased outputs are inexorably produced by biased inputs. The utility, equity, and generalizability of predictive models depend on population-representative training data with robust feature sets. So while the conventional paradigm of big data is deductive in nature-clinical decision support-a future model harnesses the potential of big data for inductive reasoning. This may be conceptualized as clinical decision questioning, intended to liberate the human predictive process from preconceived lenses in data solicitation and/or interpretation. Efficacy, representativeness and generalizability are all heightened in this schema. Thus, the possible risks of biased big data arising from the inputs themselves must be acknowledged and addressed. Awareness of data deficiencies, structures for data inclusiveness, strategies for data sanitation, and mechanisms for data correction can help realize the potential of big data for a personalized medicine era. Applied deliberately, these considerations could help mitigate risks of perpetuation of health inequity amidst widespread adoption of novel applications of big data.
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Affiliation(s)
- Eli M Cahan
- 1New York University School of Medicine, New York, NY USA.,2Department of Pediatric Orthopaedics, Stanford University, Palo Alto, CA USA
| | - Tina Hernandez-Boussard
- 3Department of Biomedical Data Sciences, Stanford University, Palo Alto, CA USA.,4Department of Medicine, Stanford University, Palo Alto, CA USA.,5Department of Surgery, Stanford University, Palo Alto, CA USA
| | | | - Daniel L Rubin
- 3Department of Biomedical Data Sciences, Stanford University, Palo Alto, CA USA.,4Department of Medicine, Stanford University, Palo Alto, CA USA.,6Department of Radiology, Stanford University, Palo Alto, CA USA
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