Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool

BACKGROUND & AIMS

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share).

METHODS

A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool.

RESULTS

Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001).

CONCLUSION

A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.

Compromised hepatic detoxification in companion animals and its correction via nutritional supplementation and modified fasting

Dietary components play a crucial role in the health of companion animals, especially those exposed to elevated levels of toxins and free radicals. Investigation into animals' hepatic antioxidant and metabolite conjugation systems, and the metabolic processes that influence them, provides some understanding regarding the relationship of diet to disease prevention and treatment. A review of current literature and research publications suggests nutritional supplementation can be an effective treatment for animals suffering from increased oxidative stress and toxicity. The results of recent in vivo assessments, clinical trials, and observational studies show oral supplementation with vitamin E, selenium, glutathione, and taurine to be beneficial for both maintaining natural antioxidant systems and protecting against a number of degenerative diseases associated with free radical damage and toxin exposure. In many instances, it has been observed that the introduction of specific nutrients positively influences the health status, symptomatic presentation, and life span of animals whose natural detoxification systems are compromised.

Embracing the continuum of care: an Australian private hospital's experience

Continuity of care throughout the home, community, and hospital settings is essential in providing quality health care. A continuum-of-care model assists in improving communication between all stakeholders, decreases confusion, and ensures appropriate provision of resources so that patient/client care needs are met. Historically, continuity of care has been difficult to provide because care delivery has taken place in separate settings. In addition, appropriate processes, incentives and resources have not been in place to ensure sufficient interaction between care providers. In Australia the concept of case management has been inviting because it acknowledges the importance of continuity of care. It also addresses pressures on the health care system to ensure quality, cost-effective service provision. The extent to which continuity of care is provided depends on the flexibility of the case management model including the flexibility of care providers to interact between settings. This article presents an Australian private hospital's experience utilizing a case management model. Three specialties (Home Care, Oncology, and Medical) will be used as examples demonstrating how the model incorporates the continuum of care concept. Their challenges in providing continuity of care beyond the hospital walls are explored.