1
|
Thoft Jensen B, Bjerggaard Jensen J. One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy. Cancers (Basel) 2023; 15:5785. [PMID: 38136331 PMCID: PMC10741904 DOI: 10.3390/cancers15245785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients' functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.
Collapse
Affiliation(s)
- Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Public Health, Aarhus University, 8200 Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| |
Collapse
|
2
|
Gyergyek A, Rotovnik Kozjek N, Klen J. Monitoring the effect of perioperative nutritional care on body composition and functional status in patients with carcinoma of gastrointestinal and hepatobiliary system and pancreas. Radiol Oncol 2023; 57:371-379. [PMID: 37439751 PMCID: PMC10561066 DOI: 10.2478/raon-2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. PATIENTS AND METHODS 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. RESULTS Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs. -2,1% in group 2). There was no difference in handgrip strength. CONCLUSIONS Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.
Collapse
Affiliation(s)
- Andrej Gyergyek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nada Rotovnik Kozjek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Clinical Nutrition, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jasna Klen
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
3
|
Banks MD, Webster J, Bauer J, Dwyer K, Pelecanos A, MacDermott P, Nevin A, Coleman K, Campbell J, Hickling D, Byrnes A, Capra S. Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study. J Wound Care 2023; 32:292-300. [PMID: 37094924 DOI: 10.12968/jowc.2023.32.5.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. METHOD Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. RESULTS Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. CONCLUSION This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.
Collapse
Affiliation(s)
- Merrilyn D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Joan Webster
- Centre for Clinical Nursing, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Judy Bauer
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Kathleen Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Anita Pelecanos
- Metro North Hospital and Health Service Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Paula MacDermott
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Amy Nevin
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kerrie Coleman
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Donna Hickling
- Department of Nutrition & Dietetics, The Prince Charles Hospital, Chermside, Australia
| | - Angela Byrnes
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Sandra Capra
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
| |
Collapse
|
4
|
van den Berg G, de van der Schueren M, Vermeulen H, Huisman-de Waal G. Opportunities for Patient Participation in Perioperative Malnutrition Care: A Qualitative Study. SAGE Open Nurs 2023; 9:23779608231193743. [PMID: 37691726 PMCID: PMC10483977 DOI: 10.1177/23779608231193743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/26/2023] [Accepted: 07/22/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care. Objective This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization. Methods A qualitative study was conducted using an interpretive phenomenological approach. To follow patients' experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process. Results Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care. Conclusion Awareness and responsiveness to patients' perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.
Collapse
Affiliation(s)
- Gerda van den Berg
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Hester Vermeulen
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Center–Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Ancira-Moreno M, Omaña-Guzmán I, Bautista-Morales AC, Acosta-Ruiz O, Hernández Cordero S, Burrola-Méndez S, Vilar-Compte M, Monterrubio Flores E, Kaufer-Horwitz M, Pérez Navarro C, Muñoz-Manrique C, Mazariegos M, Trejo-Domínguez A, Sánchez Muzquiz B, Cajero A, Brero M, Sachse M, Cobo Armijo F. Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care. Front Med (Lausanne) 2022; 9:1011940. [PMID: 36569141 PMCID: PMC9769120 DOI: 10.3389/fmed.2022.1011940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC. Methods We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted. Results Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.
Collapse
Affiliation(s)
| | | | | | - Omar Acosta-Ruiz
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Sonia Hernández Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | | | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Eric Monterrubio Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Cinthya Muñoz-Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Ariana Cajero
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Matthias Sachse
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Fernanda Cobo Armijo
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| |
Collapse
|
6
|
Søe Jensen P, Nørholm V, Poulsen I, Vendel Petersen H. Dialogue is a prerequisite for the nurse-patient relationship in nutritional care: A secondary analysis using the fundamentals of care framework. Scand J Caring Sci 2022; 36:1206-1216. [PMID: 35778822 PMCID: PMC9795910 DOI: 10.1111/scs.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/01/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Providing good nutritional care is complex as it goes beyond assessing and ensuring the patients' dietary needs. So far, nutritional research has mainly focused on establishing evidence for the nutritional treatment, while less attention has been on the complexity of providing nutritional care. The Fundamentals of Care (FoC) describes five elements (focus, knowledge, anticipate, evaluate and trust) essential for establishing a nurse-patient relationship as a foundation for quality care. By studying how these elements shape nutritional care and dialogue, we can explore and describe the complexity of nutritional care. AIM By using the FoC framework as an analytic framework, this study explores how the nurse-patient relationship shapes the nutritional care of orthopaedic patients. METHOD This study is a secondary analysis using deductive content analysis of interviews with patients undergoing major orthopaedic surgery, nursing staff and observations of interactions between nursing staff and patients. The core dimension of the FoC framework, 'Establishment of relationship,' was used as an analytic framework. RESULT The nurses perceived serving meals and providing nutritional supplements as an essential part of the nutritional care. Still, the nutritional care was organised as a routine task to be less time-consuming. Appropriate care was initiated when the nursing staff explored patients´ food preferences. When the nursing staff failed to familiarise themselves with the patient's preferences, the patients interpreted nutritional care as unrelated to their needs, resulting in a lack of trust. CONCLUSION The need for efficiency within nutritional care must not compromise the patients' need for dialogue with the nurse. Establishing a trusting relationship between nurses and patients prevents nutritional care from becoming a routine task unrelated to the patients' needs.
Collapse
Affiliation(s)
- Pia Søe Jensen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Department of Orthopaedic SurgeryCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark
| | - Vibeke Nørholm
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark
| | - Ingrid Poulsen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark,Department of Brain InjuryCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | | |
Collapse
|
7
|
Vrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners. Healthcare (Basel) 2022; 10:2222. [PMID: 36360563 PMCID: PMC9691229 DOI: 10.3390/healthcare10112222] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 08/04/2023] Open
Abstract
Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.
Collapse
Affiliation(s)
- Aleksandra Vrkatić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Grujičić
- Department of General Education Subjects, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Jelena Jovičić-Bata
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Budimka Novaković
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| |
Collapse
|
8
|
Murphy JL. Improving nutrition and hydration in older people with dementia in care homes. Nurs Older People 2022; 34:e1389. [PMID: 36069186 DOI: 10.7748/nop.2022.e1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
Dementia can have significant adverse effects on people's ability to eat and drink sufficiently. People with dementia can experience malnutrition and unintentional weight loss at any stage of the condition, but these occur more often in the middle and late stages. It is important that nurses and care staff working in care homes have the appropriate knowledge and skills to provide optimal nutritional care to residents, thereby improving their health, well-being and quality of life. This article provides an overview of nutrition and hydration issues commonly experienced by people with dementia. It explores common causes of suboptimal nutrition and hydration, outlines tools for nutritional screening and assessment and discusses interventions to improve the nutritional care of care home residents with dementia.
Collapse
Affiliation(s)
- Jane Louise Murphy
- Ageing and Dementia Research Centre, Bournemouth University, Bournemouth, England
| |
Collapse
|
9
|
Taïeb A, Gaëlle L, Roxane D, Perrine W, Marion A, Fleur B, Zoé L, Aurélie L, Solen D, Patricia D, Véronique A. Efficiency of a multidisciplinary team care approach through a short hospitalization of patients with poorly controlled diabetes mellitus: a 12 months prospective monocentric study. Pan Afr Med J 2022; 41:192. [PMID: 35685103 PMCID: PMC9146601 DOI: 10.11604/pamj.2022.41.192.23965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
A multidisciplinary team is composed of various healthcare professionals that ensure a multifaceted approach on a group of patients. Standards for diabetes medical care note the importance of multidisciplinary diabetes care teams. We applied our model of multidisciplinary approach by structuring it in a determined five days hospitalization. The aim of this study was to determine if the interdisciplinary approach applied on a short hospitalization is of benefit in patients with poorly controlled diabetes mellitus. Sixty-seven patients were included and ensured a short hospitalization in which they received a multiple educational advice and a treatment adaptation. Sixty-one patients out of 67 (91%) were retained for evaluation with sufficient data at one year, i.e. 9% of patients with poor compliance. Evolution in glycosylated haemoglobin (HbA1c), weight and treatments was analyzed. After a 12 months follow-up, we observed significant improvement in HbA1c (-1.73%; p < 103) without weight loss (BMI=-0.42 kg/m2), p=0.28). HbA1c mean levels correlated negatively to body mass index (BMI) during the regular follow-up (r=-0.22, p=0.05). More than 90% of patients with poorly controlled diabetes mellitus responded to the multi-disciplinary approach with a decrease in HbA1c.
Collapse
Affiliation(s)
- Ach Taïeb
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
- University of Sousse, Faculty of Medicine of Sousse, 4000, Sousse, Tunisia
- University Hospital Farhat Hached, Sousse, Tunisia
| | - Lemdjo Gaëlle
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ducloux Roxane
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Wojewoda Perrine
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Albentosa Marion
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Bougeniere Fleur
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Leriche Zoé
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Leveque Aurélie
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Dennetiere Solen
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Dutrieux Patricia
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| | - Averous Véronique
- Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France
| |
Collapse
|
10
|
Lindner-Rabl S, Wagner V, Matijevic A, Herzog C, Lampl C, Traub J, Roller-Wirnsberger R. Clinical Interventions to Improve Nutritional Care in Older Adults and Patients in Primary Healthcare - A Scoping Review of Current Practices of Health Care Practitioners. Clin Interv Aging 2022; 17:1-13. [PMID: 35023909 PMCID: PMC8747528 DOI: 10.2147/cia.s343307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
In light of the increasing life expectancy of Europe's population and the rising significance of active and healthy ageing relating thereto, an integrated approach of nutritional care within primary health care is gaining importance. The aim of the review was to summarize evidence on the effectiveness of nutritional interventions in primary health care. The scoping review is based upon a comprehensive literature search of relevant literature published between January 2010 and August 2021 in PubMed, CINAHL, Cochrane Database of Systematic Reviews, Embase and Medline databases. Overall, 15 studies were included for evidence synthesis and interventions were basically clustered according to their type, into 1) eHealth and tele-medical interventions; 2) targeted single interventions; and 3) comprehensive, multi-faceted interventions. The review presents diverging evidence regarding the efficacy and effectiveness of interventions for nutritional care in primary health care, however, demonstrates encouraging outcomes. eHealth and tele-medical interventions partly show a careful positive tendency. Likewise, manifold single interventions on patient level present significant improvements in patient health outcomes. Multifaceted and comprehensive interventions found in the literature also partly demonstrate significant changes in intervention groups. Primary health care represents a critical setting for the care of older citizens and patients with complex health needs. This scoping review provides an overview of current nutrition care practices in primary health care and results reinforce the need to strengthen implementation of multi-faceted interventions carried out by the inter-disciplinary primary care team for advanced nutritional care.
Collapse
Affiliation(s)
- Sonja Lindner-Rabl
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Valentina Wagner
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Andreas Matijevic
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Carolin Herzog
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Christina Lampl
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| | - Julia Traub
- University Hospital Graz, Department of Clinical Medical Nutrition, Graz, Austria
| | - Regina Roller-Wirnsberger
- Medical University of Graz, Department of Internal Medicine, Research Unit for Aging and Old Age Medicine, Graz, Austria
| |
Collapse
|
11
|
Pancheva R, Zhelyazkova D, Ahmed F, Gillon-Keren M, Usheva N, Bocheva Y, Boyadzhieva M, Valchev G, Yotov Y, Iotova V. Dietary Intake and Adherence to the Recommendations for Healthy Eating in Patients With Type 1 Diabetes: A Narrative Review. Front Nutr 2022; 8:782670. [PMID: 34977126 PMCID: PMC8716953 DOI: 10.3389/fnut.2021.782670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Medical nutrition therapy is essential for all people with diabetes, of any type or severity. Compliance with the recommended nutrition is an integral part of the treatment of type 1 diabetes (T1D). It remains unclear to what extent the dietary intake of patients with type 1 diabetes adheres to the recommendations for healthy eating. Objective: The primary aim of our study is to collect and analyze published articles on the nutrition of T1D patients in comparison with the general population and recommendations. Research Strategy and Methods: A literature search for articles, published between January 2006 and July 2021 was conducted, using electronic databases (PubMed and Google Scholar) for all available publications in English and Bulgarian. The process of study selection, identification, screening, eligibility and inclusion followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations for a flowchart. Based on the keywords search, 425 titles were retrieved, of which 27 were selected based on title and abstract. All papers were crosschecked and reviewed for selection by 3 independent reviewers. As a result, 19 titles were eligible and met inclusion criteria for a full review. Results: Energy intake tends to be lower in T1D patients or comparable to controls and in most cases within the general recommendations. The percentage of calories from protein is within the recommendations for children, adolescents and adults. Only two studies showed that T1D patients consume significantly less than the recommendation for total fat intake (<35E%). The median intake of carbohydrates is in the lower end of the recommended 45 to 60E%. The median intake of dietary fiber adjusted for total energy is too low for T1D patients and the general population. Conclusion: Study findings suggested a lack of knowledge or misunderstanding of diabetes dietary management. Patients with T1D, who are being consulted with a dietician as a part of their treatment plan may have better compliance to their recommended diet and as a result, are likely to have better health outcomes. Nutritional therapy should focus not only on glycemic control and pure carbohydrate counting but also on healthy eating and complication prevention.
Collapse
Affiliation(s)
- Rouzha Pancheva
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Desislava Zhelyazkova
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Fatme Ahmed
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Michal Gillon-Keren
- Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nataliya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Yana Bocheva
- Department of Clinical Laboratory, Medical University of Varna, Varna, Bulgaria
| | - Mila Boyadzhieva
- Department of Internal Diseases II, Medical University of Varna, Varna, Bulgaria
| | - Georgi Valchev
- Department of Imaging Diagnostics, Interventional Radiology and Radiotherapy, Medical University of Varna, Varna, Bulgaria
| | - Yoto Yotov
- Department of Internal Diseases I, Medical University of Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, Varna, Bulgaria
| |
Collapse
|
12
|
Abstract
Patients with advanced or metastatic gastric cancer often suffer from malnutrition, which can have an impact on quality of life, increase the toxicity of chemotherapy and reduce overall survival. Options available to the clinician to manage a patient's nutritional status include screening and assessment of malnutrition at diagnosis, monitoring during the 'cancer journey', early detection of precachexia and the ongoing use of a multidisciplinary team (oncologists, other medical specialists and nutritionists). Because malnutrition is frequently overlooked and under treated in patients with advanced or metastatic gastric cancer, this narrative review focuses on the clinical meaning of nutritional status in gastric cancer and provides general guidance regarding nutritional care management for patients with advanced or metastatic gastric cancer.
Collapse
Affiliation(s)
- Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University, Kawasaki, 216-8511, Japan
| | | |
Collapse
|
13
|
Kao CC. [ Nutritional Care of Older Adult Residents Living in Long-Term Care Facilities]. Hu Li Za Zhi 2021; 68:26-32. [PMID: 34013503 DOI: 10.6224/jn.202106_68(3).05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An estimated one-fifth to one half (17.5%-50.5%) of the older adult residents living in long-term care facilities are either malnourished or at risk of malnourishment. Malnutrition in older adults is related to frailty, sarcopenia, anemia, falls, morbidity, and mortality. Monitoring nutritional status and instituting appropriate nutritional care plans in long-term care facilities can help prevent the development of disabilities in older adult residents and reduce long-term healthcare expenditures. In this article, after introducing the primary diagnostic tests for malnutrition, the three main nutritional care principles are presented in the following categories: non-specific health problems, specific-health problems, and dehydration are presented. Next, the behavioral-environmental factors of nutritional care are defined. Finally, the related challenges and practical recommendations are discussed.
Collapse
Affiliation(s)
- Chia-Chan Kao
- PhD, RN, Associate Professor, Department of Nursing, I-Shou University, Taiwan, ROC.
| |
Collapse
|
14
|
Lawrence V, Hickson M, Weekes CE, Julian A, Frost G, Murphy J. A UK survey of nutritional care pathways for patients with COVID-19 prior to and post-hospital stay. J Hum Nutr Diet 2021; 34:660-669. [PMID: 33735530 PMCID: PMC8250968 DOI: 10.1111/jhn.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/06/2023]
Abstract
Background During the global COVID‐19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID‐19 infection prior to and after discharge. Methods Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. Results Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID‐19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first‐line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were ‘very or reasonably confident’ in their team's nutritional management of COVID‐19. Less than half (42%) reported on training needs. Conclusions Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID‐19 infection. Further work is needed to develop strategies for evaluation of their impact.
Collapse
Affiliation(s)
- Victoria Lawrence
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Mary Hickson
- Plymouth Institute of Health Research, University of Plymouth, Plymouth, UK
| | - C Elizabeth Weekes
- Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - Anna Julian
- Nutrition and Dietetics, NHS Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
| | - Gary Frost
- Nutrition and Dietetic Research Group, Imperial College London, London, UK
| | - Jane Murphy
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| |
Collapse
|
15
|
Ten Cate D, Schoonhoven L, Huisman-de Waal G, Schuurmans MJ, Ettema RGA. Hospital and home care nurses' experiences and perceptions regarding nutritional care for older adults to prevent and treat malnutrition: A cross-sectional study. J Clin Nurs 2021; 30:2079-2092. [PMID: 33829601 DOI: 10.1111/jocn.15764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. BACKGROUND In-depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. DESIGN Multicentre cross-sectional descriptive study. METHOD A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. RESULTS The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. CONCLUSION Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. RELEVANCE TO CLINICAL PRACTICE Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well-positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home.
Collapse
Affiliation(s)
- Debbie Ten Cate
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roelof G A Ettema
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
16
|
Ten Cate D, Mellema M, Ettema RGA, Schuurmans MJ, Schoonhoven L. Older Adults' and Their Informal Caregivers' Experiences and Needs regarding Nutritional Care Provided in the Periods before, during and after Hospitalization: A Qualitative Study. J Nutr Gerontol Geriatr 2021; 40:80-107. [PMID: 33835889 DOI: 10.1080/21551197.2021.1906822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults' and informal caregivers' perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults' and informal caregivers' perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.
Collapse
Affiliation(s)
- Debbie Ten Cate
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mattanja Mellema
- Care Needs Assessment Centre, Utrecht, the Netherlands
- Clinical Health Sciences, Utrecht University, Utrecht, the Netherlands
| | - Roelof G A Ettema
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
17
|
Yinusa G, Scammell J, Murphy J, Ford G, Baron S. Multidisciplinary Provision of Food and Nutritional Care to Hospitalized Adult In-Patients: A Scoping Review. J Multidiscip Healthc 2021; 14:459-491. [PMID: 33654405 PMCID: PMC7910096 DOI: 10.2147/jmdh.s255256] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Multidisciplinary approaches to nutritional care are increasingly emphasized and recommended. However, there is little evidence of how different disciplines work together collaboratively to deliver optimum quality care to adult in-patients. This scoping review aimed to describe the existing literature on multidisciplinary collaboration to identify the various disciplines involved and the features that influence collaborative working in implementing multidisciplinary food and nutritional care with adult in-patients. METHODS Multiple databases were searched, including MEDLINE Complete, Embase, CINAHL Complete, HMIC, and Scopus, from their inception to December 2019. Data were retrieved from eligible studies. A narrative description of findings is reported with respect to the disciplines involved, the aspects of nutritional care explored, and the collaborative processes categorized using the input, process, and outcome framework. RESULTS Thirty-one studies with heterogeneous study designs met the eligibility criteria. Studies were undertaken in six countries. Findings show a wide diversity of multidisciplinary collaborations in various aspects of nutritional care in all studies. Multidisciplinary nutritional care provision was facilitated by several processes, including training and development, communication and information sharing, and clinical leadership and management support. Outcomes were reported at the patient, team, and organizational levels. CONCLUSION This review reveals the significance of the interrelationship between different disciplines and their complementary contributions towards the delivery of optimal food and nutritional care. Key aspects include the involvement of different disciplines, the clarification of roles and multidisciplinary interrelationships, communication, information sharing, clinical leadership, and management support, all of which facilitated collaborative working. Our review uncovered that these features can significantly influence multidisciplinary working. This review is the first to present literature concerning the attributes that affect collaborative working. Further research is recommended specifically around multidisciplinary nutritional care processes and conditions that allow for better collaborative working.
Collapse
Affiliation(s)
- Gladys Yinusa
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Janet Scammell
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Jane Murphy
- Ageing and Dementia Research Centre, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Gráinne Ford
- Dietetic Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Dorset, UK
| | - Sue Baron
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| |
Collapse
|
18
|
Ostrowska J, Sulz I, Tarantino S, Hiesmayr M, Szostak-Węgierek D. Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey. Nutrients 2021; 13:263. [PMID: 33477640 DOI: 10.3390/nu13010263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 12/20/2022] Open
Abstract
NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p < 0.05). However, the prevalence of some nutritional risk factors, i.e., recent weight loss, history of decreased food intake, and low actual food intake, were approximately four times more prevalent than diagnosed malnutrition (referring to approximately 40-50% of all participants). In comparison to the European reference group, the significant differences observed in Polish hospital wards concerned mainly dietitian's involvement in the process of treating malnutrition (16% vs. 57.2%; p < 0.001); supply of special diets (8% vs. 16.1%; p < 0.0001); provision of oral nutritional support (ONS) (3.8% vs. 12.2%; p < 0.0001); prescription of enteral/parenteral nutrition therapy to hospitalized patients (8.2% vs. 11.7%; p < 0.001); as well as recording patient weight performed at hospital admission (100% vs. 72.9%; p < 0.0001), weekly (20% vs. 41.4%; p < 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention.
Collapse
|
19
|
Berggren E, Törnkvist L, Ödlund Olin A, Orrevall Y, Strang P, Hylander I. District nurses and general practitioners' negotiation of responsibility for nutritional care for patients in palliative phases cared for at home. Prim Health Care Res Dev 2020; 21:e58. [PMID: 33298234 DOI: 10.1017/S1463423620000560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore district nurses and general practitioners (GPs) interaction in a case seminar when discussing nutritional care for patients in palliative phases cared for at home and to construct a theoretical model illuminating the professionals’ main concern. Background: Nutritional care for people who are frail and older requires collaboration between nurses and physicians in primary health care. However, both collaboration and knowledge need to be improved, and there is a lack of continuing interprofessional education to meet these needs. We therefore developed an interprofessional educational intervention about nutritional care for patients in palliative phases of disease that was adapted to primary home health care and ended with a case seminar. The case seminar discussions gave us the opportunity to study micro-level interactions between district nurses and GPs in a learning context. Methods: Grounded theory method was used to construct a theoretical model of the interactions between district nurses and GPs as they discussed an authentic case. Findings: A substantive grounded theory that illuminates how district nurses and GPs interacted, negotiating responsibility for nutritional care for patients in palliative phases cared for at home. The theory is described in a tentative theoretical model that delineates factors that facilitate interprofessional dialogue and lead to interprofessional learning, or block such dialogue and learning. The theoretical model illuminates the importance of a distinction between uniprofessional and interprofessional dialogue in interprofessional educational interventions. It suggests that interprofessional learning was generated directly from the interaction between district nurses and GPs in the case seminar discussions. The model can be used to promote better teamwork and collaboration in caring; for example, as a basis for reflection in collaborative and interprofessional learning interventions and as a tool for facilitators and teachers.
Collapse
|
20
|
Rosti G, Romano F, Secondino S, Caccialanza R, Lobascio F, Carminati O, Pedrazzoli P, Tralongo P. The Role of Nutritional Support in Cured/Chronic Patients. Nutrients 2020; 12:nu12103167. [PMID: 33081215 PMCID: PMC7602732 DOI: 10.3390/nu12103167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/03/2022] Open
Abstract
Improvements in Clinical Oncology, due to earlier diagnoses and more efficient therapeutic strategies, have led to increased numbers of long-term survivors, albeit many with chronic diseases. Dealing with the complex care needs of these survivors is now an important part of Medical Oncology. Suitable diet and physical activity regimes will be important in maintaining their health. This paper will review what we know and what we can do in the near future for these patients.
Collapse
Affiliation(s)
- Giovanni Rosti
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Correspondence:
| | - Fabrizio Romano
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
| | - Simona Secondino
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy; (R.C.); (F.L.)
| | - Ornella Carminati
- Medical Oncology, Department of Oncology and Hematology, AUSL Romagna, 48100 Ravenna, Italy;
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (S.S.); (P.P.)
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Paolo Tralongo
- Medical Oncology Department, Ospedale Umberto 1-RAO-Siracusa, 96100 Syracuse, Italy; (F.R.); (P.T.)
| |
Collapse
|
21
|
Nagano A, Maeda K, Koike M, Murotani K, Ueshima J, Shimizu A, Inoue T, Sato K, Suenaga M, Ishida Y, Mori N. Effects of Physical Rehabilitation and Nutritional Intake Management on Improvement in Tongue Strength in Sarcopenic Patients. Nutrients 2020; 12:nu12103104. [PMID: 33053651 PMCID: PMC7601202 DOI: 10.3390/nu12103104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 ± 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 ± 8.9 kPa to 30.5 ± 7.6 kPa as a result of the treatment (p < 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of ≥30 kcal/kg/day and a protein intake of ≥1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53-1.70]; p < 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.
Collapse
Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan;
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
- Correspondence: ; Tel.: +81-561-62-3311; Fax: +81-561-78-6364
| | - Masaki Koike
- Division of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahimachi, Kurume 830-0011, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wago-kita, Naka-ku, Hamamatsu, Shizuoka 433-8127, Japan;
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata 950-3198, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Japan;
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;
| |
Collapse
|
22
|
Chareh N, Kiesswetter E, Rappl A, Stehle P, Heseker H, Sieber CC, Volkert D. Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care. Healthcare (Basel) 2020; 8:E296. [PMID: 32854303 DOI: 10.3390/healthcare8030296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5–9.7], IC-LO 1.4 [0.3–6.6], IC-LA 1.4 [0.3–6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.
Collapse
|
23
|
Abstract
During the Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa, practitioners faced challenges providing nutritional care for patients in Ebola treatment units (ETUs). The current EVD outbreak in the Democratic Republic of the Congo demonstrates the need to understand lessons learned from previous outbreaks and to update nutritional guidelines. We conducted a literature review to identify articles that included nutrition as an integral part of supportive care. We found little information on the specific nutritional care or practical challenges within an ETU. This review showed that nutritional care for EVD patients is poorly described, and therefore the optimal composition and implementation of nutritional care remain unknown. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutritional support within ETUs to expand the knowledge base and ultimately improve the nutritional care for an increasingly prevalent patient population.
Collapse
|
24
|
Samuelsson L, Södergren M, Berggren E, Törnkvist L. 'Prevent undernutrition and prescribe oral nutritional supplements correctly': an educational intervention for district nurses. Prim Health Care Res Dev 2019; 20:e152. [PMID: 31813385 DOI: 10.1017/S1463423619000690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: The aim of this study was to evaluate district nurses’ (DN) perceived nutritional care and actual level of knowledge about nutritional care before and after a continuing educational intervention. Background: Nutritional treatment is an important part of nursing care, and health professionals responsible for nutritional care for older adults must therefore have sufficient understanding of nutritional problems to provide appropriate support. Previous research has shown that nutritional problems frequently go unrecognized and that health care personnel often lacks knowledge about nutritional care and relevant methods of assessing nutritional status. However, little is known about DNs’ knowledge about nutritional care. Methods: An evaluative study with a study-specific questionnaire administered before and after a 2.5-day continuing educational course for DNs in primary health care in Stockholm County, Sweden. The course was given over a period of two to three months. The questionnaire measured DNs’ perceived nutritional care and actual level of knowledge about nutritional care. Findings: A total of 456 DNs completed the questionnaire both before and after the intervention. Participants’ mean age was 50 years. They had worked a mean of 26 years in health care and 10 years as DNs. Before the intervention, many DNs reported that they did not work with nutritional care in an optimal way. After the intervention, significant improvements were found in perceived nutritional care and actual level of knowledge about the topic. However, not all DNs achieved the learning objectives of the course, so work remains to be done to ensure that DNs have sufficient knowledge of nutritional care to provide appropriate support and correctly prescribe oral nutritional supplements. Conclusions: The study provides new information on DNs’ perceived nutritional care and actual level of knowledge. The result of the intervention helps lay the foundation for good nutritional care for older patients in primary care.
Collapse
|
25
|
Koffi YD, Konan AG, Delmont J, Adjet AA, Rey JL. Nutritional approach to management of Buruli ulcer in Côte d'Ivoire. Med Sante Trop 2019; 29:409-14. [PMID: 31884996 DOI: 10.1684/mst.2019.0935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children in developing tropical countries are frequently undernourished. In rural areas, they are also often affected by Buruli ulcers. The treatment of this mutilating disease is sometime long and difficult for malnourished patients. Moreover, the eating behavior of patients with Buruli ulcers does not promote its quick healing, with numerous foods prohibited. They eat fewer fruits and legumes, which are rich in vitamins and minerals. Our survey in two health centers showed that only 8% ate fruits and legumes, and 29% leafy greens. This food deprivation increases their nutritional deficiencies. We conducted a nutritional intervention among Buruli ulcer patients (30 patients) in one center, and compared their healing with that of Buruli patients without nutritional care (n = 21). Those patients who received the intervention spent less time at the hospital (less than six months). Our study shows the association between the healing of Buruli ulcers in Côte d'Ivoire and good nutritional status: those with the intervention healed faster and presented fewer disabilities than the control patients.
Collapse
|
26
|
Abstract
BACKGROUND Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival. SUBJECTS AND METHODS An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care. RESULTS Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements. CONCLUSION Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.
Collapse
Affiliation(s)
- Judy Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elena J Ladas
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Paul C Rogers
- Division of Pediatric Oncology/Haematology/BMT, BC Children's Hospital and University of BC, Vancouver BC, Canada
| | - Suvekshya Aryal
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, USA
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
27
|
Ben-Porat T, Weiss-Sadan A, Rottenstreich A, Sherf-Dagan S, Schweiger C, Yosef-Levi IM, Weiner D, Azulay O, Sakran N, Harari R, Elazary R. Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review. Adv Nutr 2019; 10:122-132. [PMID: 30753268 PMCID: PMC6370259 DOI: 10.1093/advances/nmy112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgery (BS) may be effective for chronic kidney disease (CKD) patients by reducing microalbuminuria and proteinuria, and by facilitating their meeting inclusion criteria for kidney transplantation. However, nutritional management for this population is complex and specific guidelines are scarce. A literature search was performed to create dietetic practice for these patients based on the most recent evidence. For the purposes of nutritional recommendations, we divided the patients into 2 subgroups: 1) patients with CKD and dialysis, and 2) patients after kidney transplantation. Before surgery, nutritional care includes nutritional status evaluation and adjusting doses of supplements to treat deficiencies and daily nutrient intake according to the dietary restrictions derived from kidney disease, including quantities of fluids, protein, phosphorus, potassium, and vitamins. After BS, these patients are at major risk for lean body mass loss, malnutrition and dehydration because of fluid restriction and diuretics. Postoperative nutritional recommendations should be carefully tailored according to CKD nutritional limitations and include specific considerations regarding protein, fluids, and supplementation, in particular calcium, vitamin A, and vitamin D. Nutritional management of CKD and kidney transplant patients undergoing BS is challenging and future studies are required to establish uniform high-level evidence-based guidelines.
Collapse
Affiliation(s)
- Tair Ben-Porat
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Weiss-Sadan
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shiri Sherf-Dagan
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Rabin Medical Center, Petach Tiqva, Israel
| | - Irit Mor Yosef-Levi
- Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dana Weiner
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Sheba Medical Center, Tel Aviv, Israel
| | - Odile Azulay
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Rabin Medical Center, Petach Tiqva, Israel
| | - Nasser Sakran
- Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Rivki Harari
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
28
|
Mole L, Kent B, Abbott R, Wood C, Hickson M. The nutritional care of people living with dementia at home: A scoping review. Health Soc Care Community 2018; 26:e485-e496. [PMID: 29365369 PMCID: PMC6849562 DOI: 10.1111/hsc.12540] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
There are an increasing number of people with dementia living in their own home for longer, often supported by a family member. The symptoms of dementia can affect an individual's nutritional status, which can lead to a reduced quality of life for the person with dementia and their family members. A scoping review was conducted from July 2016 until September 2016, using a recognised framework, to explore what is currently known, and identify any gaps in the research regarding the nutritional care of people living with dementia at home. This included any interventions that may have been trialled or implemented, and the views of those living with dementia, carers and clinicians. Six electronic databases were searched from inception to July 2016. A review team was involved in screening and data extraction for selected articles. Published qualitative and quantitative studies were included that explored the nutritional care of people living with dementia at home. Methods included data extraction and conventional content analysis. Stakeholders were involved in the development of final categories. Following screening, 61 studies reported in 63 articles were included. Most studies were cross-sectional (n = 24), cohort (n = 15) or qualitative (n = 9). Only three were randomised controlled trials. Three overarching categories represented the results: Timely identification of nutritional risk and subsequent regular monitoring of nutritional status, multi-component tailored interventions and the influence of the care-giving dyad on nutritional status. Many studies identify people living at home with dementia as a vulnerable group prone to malnutrition; however, a lack of interventions exists to address the increased risk. There is a lack of research exploring the role of home care providers and healthcare professionals in the provision of nutritional care. Further research is required to explore how the emotional aspect of the care-giving dyad influences nutritional care.
Collapse
Affiliation(s)
- Louise Mole
- Institute of Health and CommunitySchool of Health ProfessionsPlymouth UniversityPlymouthUK
- Collaboration for Leadership in Applied Health Research and CareSouth West Peninsula (PenCLAHRC)The National Institute for Health Research (NIHR)PlymouthUK
| | - Bridie Kent
- Collaboration for Leadership in Applied Health Research and CareSouth West Peninsula (PenCLAHRC)The National Institute for Health Research (NIHR)PlymouthUK
- School of Nursing and MidwiferyPlymouth UniversityPlymouthUK
- Centre for Health and Social Care InnovationPlymouth UniversityJoanna Briggs InstitutePlymouthUK
| | - Rebecca Abbott
- Collaboration for Leadership in Applied Health Research and CareSouth West Peninsula (PenCLAHRC)The National Institute for Health Research (NIHR)PlymouthUK
| | - Chloë Wood
- Collaboration for Leadership in Applied Health Research and CareSouth West Peninsula (PenCLAHRC)The National Institute for Health Research (NIHR)PlymouthUK
- Medical SchoolUniversity of ExeterExeterUK
| | - Mary Hickson
- Institute of Health and CommunitySchool of Health ProfessionsPlymouth UniversityPlymouthUK
- Collaboration for Leadership in Applied Health Research and CareSouth West Peninsula (PenCLAHRC)The National Institute for Health Research (NIHR)PlymouthUK
| |
Collapse
|
29
|
O Connell MB, Jensen PS, Andersen SL, Fernbrant C, Nørholm V, Petersen HV. Stuck in tradition-A qualitative study on barriers for implementation of evidence-based nutritional care perceived by nursing staff. J Clin Nurs 2017; 27:705-714. [PMID: 28815783 DOI: 10.1111/jocn.14020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
Abstract
AIMS AND OBJECTIVES To explore the barriers for nutritional care as perceived by nursing staff at an acute orthopaedic ward, aiming to implement evidence-based nutritional care. BACKGROUND Previous studies indicate that nurses recognise nutritional care as important, but interventions are often lacking. These studies show that a range of barriers influence the attempt to optimise nutritional care. Before the implementation of evidence-based nutritional care, we examined barriers for nutritional care among the nursing staff. DESIGN Qualitative study. METHODS Four focus groups with thirteen members of the nursing staff were interviewed between October 2013-June 2014. The interview guide was designed according to the Theoretical Domains Framework. The interviews were analysed using qualitative content analysis. RESULTS Three main categories emerged: lacking common practice, failing to initiate treatment and struggling with existing resources. The nursing staff was lacking both knowledge and common practice regarding nutritional care. They felt they protected patient autonomy by accepting patient's reluctance to eat or getting a feeding tube. The lack of nutritional focus from doctors decreased the nursing staffs focus leading to nonoptimal nutritional treatment. Competing priorities, physical setting and limited nutritional supplements were believed to hinder nutritional care. CONCLUSION The results suggest that nutritional care is in a transitional state from experience- to evidence-based practice. Barriers for nutritional care are grounded in lack of knowledge among nursing staff and insufficient collaboration between nursing staff and the doctors. There is a need for nutritional education for the nursing staff and better support from the organisation to help nursing staff provide evidence-based nutritional care. RELEVANCE TO CLINICAL PRACTICE This study contributes with valuable knowledge before the implementation of evidence-based nutritional care. The study provides an understanding of barriers for nutritional care and presents explanations to why nutritional care has failed to become an integrated part of the daily treatment and care.
Collapse
Affiliation(s)
- Malene Barfod O Connell
- Clinical Research Centre, Optimized Senior Patient Program, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Gastroenterology Surgical Unit, Copenhagen University Hospital, Hvidovre, Denmark
| | - Pia Søe Jensen
- Clinical Research Centre, Optimized Senior Patient Program, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Signe Lindgård Andersen
- Clinical Research Centre, Optimized Senior Patient Program, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Cecilia Fernbrant
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmo, Lund University, Skåne University Hospital, MalmÃ, Sweden
| | - Vibeke Nørholm
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Helle Vendel Petersen
- Clinical Research Centre, Optimized Senior Patient Program, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
30
|
Abstract
Meal-ordering systems are an important aspect of hospital food services, informing patients of the available menu choices and supporting the collection of meal orders. Although several meal-ordering systems are used in hospitals, there has been limited research into patients' experience of these systems. Aim To explore patients' experience of written, spoken and visual menus in the acute hospital setting. Method Ten patients from a tertiary teaching hospital were asked to evaluate three meal-ordering systems, which were randomly allocated to them. Semi-structured interviews were conducted to gain an understanding of the patients' experience of meal-ordering systems. Findings The type and quality of food provided, the importance of information, the characteristics of the menu monitor, and the meal-ordering process were identified as important factors in enhancing patient satisfaction with hospital food services, regardless of the meal-ordering system used. Conclusion Patients place a high value on the quality of hospital food, and hospital food service departments should engage with patients when reviewing and designing menus. Healthcare organisations should also consider implementing spoken or visual menus to complement existing strategies to enhance patient satisfaction with hospital food services.
Collapse
Affiliation(s)
- Ella Ottrey
- Department of Nutrition and Dietetics, Monash University, Melbourne, Australia
| | - Judi Porter
- Department of Nutrition and Dietetics, Monash University, Melbourne, Australia
| |
Collapse
|
31
|
Burger C, Kiesswetter E, Gietl A, Pfannes U, Arens-Azevedo U, Sieber CC, Volkert D. Size Matters! Differences in Nutritional Care between Small, Medium and Large Nursing Homes in Germany. J Nutr Health Aging 2017; 21:464-472. [PMID: 28346574 DOI: 10.1007/s12603-016-0767-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study is to comprehensively describe nutritional care in German nursing homes (NHs) and to examine if nutritional care differs between small, medium and large NHs. DESIGN Nationwide cross-sectional postal survey. SETTING Nursing homes. PARTICIPANTS 541 NHs across Germany. MEASUREMENTS Information on structural NH characteristics and nutritional care (food provision and menu planning, nursing care, and management and quality assurance) was collected by means of a questionnaire addressed to the management of a random sample of German NHs. NHs were grouped by size as small (≤ 50 beds), medium (50 - 100 beds) or large (> 100 beds) institutions. Frequencies were used to describe nutritional care, and Chi2-test to identify differences in nutritional care by NH size. RESULTS Aspects in the domain of food provision and menu planning regarding food variety and choice were widely implemented in German NHs (77 - 100 %). Best results were achieved in the domain of nursing care, where all aspects were implemented in at least 68 % of the NHs. Aspects regarding management and quality assurance, especially those concerning staffing, i.e. the availability of an interface manager (14 %), an interdisciplinary nutrition team (12 %) and a dietician (42 %), were only rarely implemented. Differences by NH size were found between small and medium or large NHs. On the one hand, small NHs stated more often to consider individual capabilities of the residents with texture-modified food (81 % vs. 60 %, p<0.05) and produce more often hot meals at ward level on a regular base (46 % vs. 32 %, p<0.05) than large NHs. On the other hand, several aspects regarding food provision and menu planning, and management and quality assurance were significantly more often implemented in larger than smaller NHs. CONCLUSION Whereas kitchen and nursing-related aspects of nutritional care seem to be widely implemented in German NHs, management and quality assurance demands are often not met. The differences found by NH size support the hypothesis that the number of residents living in a NH has an impact on how nutritional care is performed.
Collapse
Affiliation(s)
- C Burger
- D. Volkert, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany,
| | | | | | | | | | | | | |
Collapse
|
32
|
Gerrish K, Laker S, Taylor C, Kennedy F, McDonnell A. Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study). J Adv Nurs 2016; 72:3182-3194. [PMID: 27485574 DOI: 10.1111/jan.13085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 01/04/2023]
Abstract
AIM The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. BACKGROUND Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. DESIGN A mixed method integrated knowledge translation study. METHODS The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. FINDINGS Statistically significant relationships (Chi Square) were observed between self-reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. CONCLUSION Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.
Collapse
Affiliation(s)
- Kate Gerrish
- University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | | | | | | |
Collapse
|
33
|
Merriweather JL, Salisbury LG, Walsh TS, Smith P. Nutritional care after critical illness: a qualitative study of patients' experiences. J Hum Nutr Diet 2014; 29:127-36. [PMID: 25522771 DOI: 10.1111/jhn.12287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present qualitative study aimed to explore the factors influencing nutritional recovery in patients after critical illness and to develop a model of care to improve current management of nutrition for this patient group. METHODS Patients were recruited into the study on discharge from a general intensive care unit (ICU) of a large teaching hospital in central Scotland. Semi-structured interviews were carried out after discharge from the ICU, weekly for the duration of their ward stay, and at 3 months post ICU discharge. Observations of ward practice were undertaken thrice weekly for the duration of the ward stay. RESULTS Seventeen patients were recruited into the study and, using a grounded theory approach, 'inter-related system breakdowns during the nutritional recovery process' emerged as the overarching core category that influenced patients' experiences of eating after critical illness. This encompassed the categories, 'experiencing a dysfunctional body', 'experiencing socio-cultural changes in relation to eating' and 'encountering nutritional care delivery failures'. CONCLUSIONS The findings from the present study provide a unique contribution to knowledge by offering important insights into patients' experiences of eating after critical illness. The study has identified numerous nutritional problems and raises questions about the efficacy of current nutritional management in this patient group. Adopting a more individualised approach to nutritional care could ameliorate the nutritional issues experienced by post ICU patients. This will be evaluated in future work.
Collapse
Affiliation(s)
- J L Merriweather
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - L G Salisbury
- Royal Infirmary of Edinburgh, Edinburgh, UK.,School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - T S Walsh
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - P Smith
- Royal Infirmary of Edinburgh, Edinburgh, UK.,School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
34
|
Abstract
AIMS This paper presents examples of good practice in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing practice in hospitals. BACKGROUND Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce improved nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to improve practice. DESIGN Qualitative investigation. METHODS Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes. FINDINGS Three strategies for sustaining effective nutritional practice emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good practice; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working. CONCLUSION Professionals seeking to improve nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients.
Collapse
Affiliation(s)
- Carol Chapman
- University Hospital Southampton NHS Foundation Trust, NIHR Wellcome Trust Southampton Clinical Research Facility, NIHR Southampton Biomedical Research Centre, UK; NIHR Southampton Respiratory Biomedical Research Unit, MP 218 Southampton Centre for Biomedical Research, University Hospital Southampton NHS Foundation Trust, UK
| | | | | |
Collapse
|
35
|
Vaillancourt H, Légaré F, Gagnon MP, Lapointe A, Deschênes SM, Desroches S. Exploration of shared decision-making processes among dieticians and patients during a consultation for the nutritional treatment of dyslipidaemia. Health Expect 2014; 18:2764-75. [PMID: 25135143 DOI: 10.1111/hex.12250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. OBJECTIVE Using a cross-sectional study design, we aimed to explore both dieticians' and patients' adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. METHODS Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: 'to discuss nutritional treatment options for dyslipidaemia' and 'to discuss patients' values and preferences about nutritional treatment options for dyslipidaemia'. These questionnaires were administered to the dietician-patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman's partial correlations. RESULTS Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians' and patients' intentions to adopt the targeted SDM behaviours (P < 0.05). CONCLUSIONS As perceived behavioural control seems to determine dieticians' and patients' adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice.
Collapse
Affiliation(s)
- Hugues Vaillancourt
- Institute on Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC, Canada.,Department of Food and Nutrition Sciences, Faculty of Agriculture and Food Sciences, Laval University, Quebec City, QC, Canada
| | - France Légaré
- CHUQ Research Center (Centre Hospitalier Universitaire de Québec - Hôpital St-François-d'Assise), Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marie-Pierre Gagnon
- CHUQ Research Center (Centre Hospitalier Universitaire de Québec - Hôpital St-François-d'Assise), Quebec City, QC, Canada.,Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Annie Lapointe
- Institute on Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC, Canada
| | - Sarah-Maude Deschênes
- Institute on Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC, Canada
| | - Sophie Desroches
- Institute on Nutrition and Functional Foods (INAF), Laval University, Quebec City, QC, Canada.,Department of Food and Nutrition Sciences, Faculty of Agriculture and Food Sciences, Laval University, Quebec City, QC, Canada.,CHUQ Research Center (Centre Hospitalier Universitaire de Québec - Hôpital St-François-d'Assise), Quebec City, QC, Canada
| |
Collapse
|