ORCID Profile
0000-0002-7535-1919
Current Organisations
Queensland University of Technology
,
Monash University
,
Deakin University
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Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.IJNURSTU.2016.11.002
Abstract: Protected Mealtimes is an intervention developed to address the problem of malnutrition, particularly in the hospital setting. The intervention aims to provide interruption-free time to eat during a hospital admission, thus supporting increased nutritional intake. This review aimed to determine the impact of Protected Mealtimes on the nutritional intake of hospitalised patients. The review was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42015023423) and followed the PRISMA guidelines. Meta-analyses were conducted of energy and protein intake. Seven databases were searched to identify relevant publications: Ovid MEDLINE, Embase, CINAHL Plus, PsycInfo, Scopus, Cochrane Library (including NHS economic evaluations), and NICE clinical guidelines. A supplementary internet search of Google and Google Scholar was undertaken. The search terms protect* AND (mealtime* OR "meal time*") were used for all searches. Eligible studies were original research where Protected Mealtimes was implemented in hospitals and nutritional intake measured. Studies were selected for inclusion following a systematic process of identification, screening and eligibility assessment. Two authors completed the screening and eligibility assessment, and quality assessment of included studies. The Quality Criteria Checklist for Primary Research was used to evaluate the quality of each study, whilst the overall body of evidence was assessed using the GRADE approach. One author extracted data and ran the meta-analyses, these were verified by a second author. Database and hand searching yielded 150 papers for consideration the final review library was seven studies where nutritional intake of patients had been evaluated before and after the introduction of Protected Mealtimes. No clinical trials of the intervention were identified. The meta-analyses of energy and protein intake in four observational studies found no effect in favour of Protected Mealtimes implementation. The GRADE of evidence was rated as very low. Given the small number of observational studies and the quality of evidence on the effect of the intervention on nutritional intake, we conclude that there is insufficient evidence for widespread implementation of Protected Mealtimes in hospitals. More research including clinical trials, with subgroup reporting of patients' nutritional status and estimated energy requirements are needed to further understand the merits of this complex healthcare intervention.
Publisher: Springer Science and Business Media LLC
Date: 26-03-2018
Publisher: Informa UK Limited
Date: 26-03-2018
DOI: 10.1080/01635581.2018.1445768
Abstract: Nutritional decline associated with non-surgical cancer treatment has been well documented. The implementation of an evidence-based nutrition care pathway is one approach suggested to improve the nutrition outcomes of this group of patients. We aimed to systematically review published original research to determine whether evidence-based nutrition clinical care pathways, as compared with usual care, improve outcomes for patients receiving non-surgical cancer treatment. The review was registered with PROSPERO (CRD42017048816) and followed PRISMA guidelines. The search strategy was conducted in four databases, and supplemented by an internet search, from inception to October 2016. Study quality was assessed using the Quality Criteria Checklist for Primary Research. Results were synthesized descriptively. Six reports of five studies formed the final library with a range of interventions and control practices investigated across several diagnostic groups. Nutrition outcomes were reported using multiple approaches with either no effect, or in favor of the clinical pathway intervention. Risk of bias was low in two studies with some risk in the remaining three studies. It was not possible to determine whether the effect on nutritional outcomes was attributable to care pathway implementation. The need to extend the evidence base through high-quality clinical trials was evident.
Publisher: Wiley
Date: 28-02-2016
DOI: 10.1111/JAN.12930
Abstract: This protocol paper describes a study that aims to determine if protected mealtimes implementation closes the energy deficit of 1900 kJ between estimated requirements and actual energy intake of hospitalized adults in the subacute setting. Protected mealtimes, a strategy developed to address the prevalence of malnourished hospitalized adults, aims to minimize unavoidable and unnecessary interruptions at mealtimes. It has been implemented widely with limited high-quality studies as to its effect. A pragmatic stepped wedge cluster trial. Primary outcomes are daily energy and protein intake. Funding was awarded in October 2014. In this study, protected mealtimes implementation will occur across each cluster (ward) chosen at random. A waiver of consent has been endorsed, enabling all patients to receive the intervention. Patients excluded from outcome evaluation will be those receiving end of life care and patients who are nil by mouth. The selection of patients for outcome evaluation will also occur randomly. S le size, randomization, statistical analysis and contamination issues consider the reporting guidelines of the CONSORT statement: extension to cluster randomized trials. The methods selected will ensure that the research is of high quality with conclusions useful and relevant for translation into practice settings. The study does not aim to assess whether the intervention is sustainable beyond the study period, rather it will establish whether the removal of known barriers to intervention uptake enables high fidelity with the intervention. As a result we will have a greater understanding of the nutritional consequences of protected mealtimes in subacute care.
Publisher: Wiley
Date: 02-2020
Publisher: Springer Science and Business Media LLC
Date: 05-11-2014
DOI: 10.1007/S11695-013-1101-1
Abstract: Patients who have undergone bariatric surgery have increased risks of developing micronutrient deficiencies. Translational research investigating the actual micronutrient intake of bariatric patients is limited. We examined the micronutrient intake of a multicentre cohort of laparoscopic adjustable gastric banding patients 1 year post-surgery. These data were compared to micronutrient recommendations for the general population. Consecutive patients from three bariatric surgery facilities in Melbourne, Australia, were invited to participate 12 months post-operatively. A validated food frequency questionnaire was posted to 215 prospective participants. Of the 52 participants, micronutrient intakes from food and fluids alone were below population recommendations for calcium, folate, magnesium, potassium, retinol equivalents, thiamin and vitamin E. Males did not meet the recommended intakes for zinc, and iron intakes in pre-menopausal women were insufficient. Intakes lower than recommended levels for these micronutrients suggest inadequate intake of foods from vegetable, dairy, lean meat (or alternatives) and wholegrains. Micronutrient intakes below recommended levels in this patient group can be further explained by their macronutrient intakes that suggested diets of poor nutrient density. Recommendations for supplementation in this group have wide variations, usually having been developed through the presence of clinical and biochemical deficiencies. Nutritional supplementation should be more extensive in scope and dosage than is currently recommended by some professional guidelines. Further long-term studies are needed to explore both macro- and micronutrient intakes on the morbidity and mortality of this patient population.
Publisher: MDPI AG
Date: 22-02-2019
DOI: 10.3390/NU11020453
Abstract: Understanding older patients’ dietary intake patterns may improve the timing of strategies to address hospital malnutrition. The aims of this study were to explore longitudinally the change in daily energy (kJ/day) and protein (g/day) intake, and associated factors. Data were derived using a 5-point scale to visually estimate plate waste, and known nutrient composition data. Analyses determined the change in intake between admission and day 14, and admission, day 14 and day 28, respectively. Data were available for 39 participants between admission and day 14 (median (interquartile range) age 82 (78–87) years 54% male) and 12 participants between admission, day 14 and day 28 (median (IQR) age 79 (69–84) years 58% male). From admission to day 14 there was a significant increase in the mean (SD) daily intake of energy (6177 (1879) kJ/day vs. 7213 (1903), p 0.001) and protein (63.7 (23) g/day vs. 76.4 (23.0) g/day, p = 0.003) but no change from admission to day 14 to day 28. There was a significant inverse relationship between amount consumed at admission and change in intake. Variability in elderly patients’ intake over time has implications for the timing of nutritional care and data collection in research studies.
Publisher: Wiley
Date: 05-2011
DOI: 10.1111/J.1440-1797.2011.01479.X
Abstract: Vitamin B6 is a water-soluble vitamin, important for the normal functioning of multiple organ systems. In patients receiving haemodialysis, vitamin B6 deficiency has been reported. The impact of ongoing advances in renal medicine on vitamin B6 status has not been evaluated. The aims of this review were (i) to determine the current level of vitamin B(6) deficiency in the haemodialysis population (ii) to determine the effect of current haemodialysis prescriptions on vitamin B(6) levels and (iii) to consider the impact of recent medical advances in haemodialysis on vitamin B(6) levels. Electronic databases were used to locate studies with biochemical measures of vitamin B6 between the years 2000 and 2010. Inclusion exclusion criteria were applied by two independent reviewers. Of 316 articles identified, 53 were selected for detailed review. Appropriate vitamin B6 measures and information were extracted. Eleven final studies were included. Vitamin B6 deficiency was shown to be between 24% and 56%. Dialysis reduced plasma levels by 28-48% depending on the dialyser used. Advances in renal medicine including the use of erythropoietin stimulating agents and ion exchange phosphate binding resins were shown to negatively affect vitamin B6 status. Current recommendations for supplementation range from 10-50 mg. These figures are based on older studies often with small numbers of patients. Suboptimal vitamin B6 status is common in the haemodialysis population. Advances in renal medicine and engineering of dialysis membranes may contribute to increased levels of deficiency.
Publisher: Wiley
Date: 27-09-2023
Abstract: This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings their financial, environmental and staffing outcomes and the barriers and enablers associated with their implementation. Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively. Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21) feeding animals (n = 2) industrial use (n = 11) composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes. This review summarises the waste management strategies used by hospitals worldwide that ert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.
Publisher: Informa UK Limited
Date: 27-04-2022
DOI: 10.1080/09638288.2022.2065540
Abstract: To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome. A cross-sectional, multi-centre, observational study of adults ( One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD -2.10, 95% confidence interval (CI) -3.98 to -0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake. Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitationAlmost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome.Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome.A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.
Publisher: Wiley
Date: 02-08-2015
DOI: 10.1111/JOCN.12913
Abstract: This review aimed to determine the effect of mealtime assistance provided to hospitalised patients (≥65 years) by nurses, trained staff or volunteers on nutritional and anthropometric outcomes. Malnutrition is a critical issue in hospitals with a reported prevalence of 20-50%. Nutritional supplementation has been associated with increased weight gain, improved function and decreased mortality however, other system approaches including mealtime assistance may also contribute to improving nutritional intake. A systematic literature review. Six electronic databases (CINAHL Plus, Cochrane Library, ProQuest Nursing and Allied Health Source, Scopus, PsycINFO and MEDLINE) were searched from their inception to August 2014. Inclusion criteria were hospitalised patients ≥65 years, provided mealtime assistance by nurses, volunteers or trained staff. Studies were examined for quality and risk of bias. Outcome data were combined narratively and by meta-analyses. From 5458 publications, five studies met the inclusion criteria. Studies were rated neutral and positive according to the Academy of Nutrition and Dietetics Quality Checklist. Adherence to study protocols was not always reported. Meta-analyses demonstrated significantly greater daily energy and protein intake where mealtime assistance was provided. Anthropometric outcomes generally did not differ significantly with mealtime assistance. Observation and s ling bias were noted in several studies. There is evidence that mealtime assistance increases daily energy and protein intake in hospitalised patients (≥65 years). More robust research is needed to elucidate whether this strategy may be an effective means of addressing the high prevalence of malnutrition in hospitals. The evidence identified suggests that mealtime assistance provided to hospitalised older patients (≥65 years) leads to a statistically significant increase in energy and protein intake. For many patients, this increase in both energy and protein intake will be clinically significant, reducing the gap between requirements and actual intake.
Publisher: Wiley
Date: 17-07-2023
Abstract: Hospital food service operations have been affected by the COVID-19 pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID-19 pandemic on hospital food services, particularly on food waste and the completion of food waste audits. A qualitative interview research design was used. Semi-structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty-one participants were interviewed from 12 hospitals. No questions were related to the COVID-19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis. Five themes were generated from the interviews related to COVID-19 and hospital food services impacts on practice, labour, change, technology and post-pandemic expectations. Participants reported COVID-19 negatively affected food service operations. Changes included increased food waste, contact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID-19 restrictions. Despite the impact COVID-19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post-pandemic, and may be facilitated through the operational changes forced by COVID-19.
Publisher: Wiley
Date: 06-2010
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/RMHP.S224901
Publisher: Wiley
Date: 15-11-2020
Abstract: Understanding neural responses through functional magnetic resonance imaging (fMRI) to food and food cues in middle‐older adults may lead to better treatment options to address the growing issue of malnutrition. This scoping review aimed to determine the extent, range and nature of research using fMRI, related to reward‐based regions, in response to food cues in middle to older aged adults (50 years and over). The following databases were systematically searched in July 2019: CINAHL, CENTRAL, Embase, Dissertations and Theses, Ovid Medline, PsycINFO, PsycEXTRA, Scopus and Web of Science. Studies were eligible for inclusion if participants had a mean or median age ≥50 years, utilised and reported outcomes of either a food cue task‐related fMRI methodology or resting‐state fMRI. Data from included studies were charted, and synthesised narratively. Twenty‐two studies were included. Eighteen studies utilised a task‐related design to measure neural activation, two studies measured resting state neural connectivity only and an additional two studies measured both. The fMRI scanning paradigms, food cue tools and procedure of presentation varied markedly. Four studies compared the neural responses to food between younger and older adults, providing no consensus on neural age‐related changes to food cues two studies utilised longitudinal scans. This review identified significant extent, range and nature in the approaches used to assess neuronal activity in response to food cues in adults aged 50 years and over. Future studies are needed to understand the age‐related appetite changes whilst considering personal preferences for food cues.
Publisher: Wiley
Date: 04-2009
Publisher: Wiley
Date: 13-08-2019
DOI: 10.1111/NHS.12559
Abstract: Nutrition care is a fundamental component of quality health care provided to patients in hospital, yet little is known about the staff who deliver this care and their interrelationships, and how this impacts nutrition care. In this ethnographic study on two subacute wards, 67 h of fieldwork was conducted over 3 months to explore the relationships, roles, and responsibilities of those involved at mealtimes, and the influence on meal provision. Data were analyzed inductively and thematically. Three themes describing ward culture and staff relationships emerged: (i) defining mealtime roles and maintaining boundaries (ii) balancing the need for teamwork and having time and space and (iii) effective communication supports role completion and problem solving. Lack of appreciation of workflow enablers and barriers degraded working relationships between staff with and without central roles at mealtimes. The present study informs health-care organizations on building a culture that supports interprofessional collaboration in nutrition care in the subacute setting. All staff need to be aware of their and others' mealtime roles and responsibilities to support a coordinated approach.
Publisher: Wiley
Date: 18-08-2016
Publisher: Wiley
Date: 03-2008
Publisher: Wiley
Date: 29-04-2016
Publisher: MDPI AG
Date: 11-10-2021
DOI: 10.3390/SU132011207
Abstract: Balancing the adoption of environmentally sustainable food systems in Australian healthcare and aged care settings whilst meeting nutritional requirements has never been more critical. This scoping review aimed to identify: the major authoritative reports/guidelines related to healthy and environmentally sustainable food procurement and foodservice in aged care and healthcare services released by international and Australian governments/organizations and the scope of healthy and environmentally sustainable food procurement and foodservice research and training initiatives in aged care and healthcare services implemented in Australia over the past decade. A systematic search yielded n = 17 authoritative reports/guidelines and n = 20 publications describing Australian research and training initiatives. Implementation of healthy and sustainable food procurement and foodservices were limited by staff knowledge and self-efficacy, and unsupportive management. Further intervention and monitoring of healthy and sustainable food procurement and foodservice practices is needed. Whilst professionals working in and managing these services require upskilling to apply evidence-based approaches, no system-wide training programs are currently available. There is an urgent need to resolve the existing gap between recommendations to adopt environmentally sustainable practices and staff training across these sectors.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2017
Publisher: MDPI AG
Date: 31-01-2017
DOI: 10.3390/NU9020099
Publisher: Wiley
Date: 17-10-2020
DOI: 10.1111/JHN.12824
Abstract: Ageing populations show a propensity for reduced food intake, which impacts nutritional adequacy. Nutrition guidelines for residential care homes (RCHs) are currently based on serve size of core food groups and do not consider nutrient density. The present study aimed to investigate the weight of foods served/consumed compared to recommended serve sizes and to compare energy and protein intake with in idual requirements. This was an observational study of older adults living in four RCHs. Dietary intake was estimated through the difference between weighed reference meals and a single, double-weighed 24-h food plate waste collected from each participant. FoodWorks9 Across 420 participants, 9.8% completed a main meal (lunch or dinner). The servings provided [248 g interquartile range (IQR) = 206-290 g] were less than the recommended servings for a main meal (306 g = protein/starch/two vegetables), with 157 g (IQR = 109-221 g) consumed. The menu provided for minimum serves of all core food groups except for dairy. Median energy intake (n = 389) (5272 kJ day Nutritional needs were not met in this cohort. The findings of the present study highlight the need for smaller, nutrient-dense meals and revised menu standards to ensure nutritional adequacy in this vulnerable population.
Publisher: MDPI AG
Date: 17-12-2016
DOI: 10.3390/NU8120815
Publisher: Wiley
Date: 25-03-1970
DOI: 10.1111/JHN.12308
Abstract: Disease-related malnutrition is known to have significant clinical and economic consequences. This systematic review of recent evidence aimed to establish the cost-effectiveness of identifying and treating malnutrition in the hospital setting. A search of four electronic databases and the Internet was conducted for relevant publications from 2003 to 2013. The search strategy considered both nutritional care and healthcare costs. Hospitalised adults with, or at risk of malnutrition, were the focus of the review. Eligibility criteria included publications of original research to identify or treat malnutrition through usual care. Studies with a focus on enteral and parenteral nutrition interventions were beyond the scope of the review. Methodological quality was assessed using the Consensus on Health Economic Criteria checklist. Of the 1174 records identified through database searching, 19 full-text articles were assessed for eligibility. Three studies were included in the final review, highlighting the absence of recent high quality cost-effectiveness studies in this field. One economic modelling study and two prospective clinical trials were included of moderate to high methodological quality. Definite conclusions could not be drawn regarding the cost-effectiveness of in idual interventions because of the heterogeneity of treatments, controls and populations. The present review highlights an evidence gap in the care of malnourished hospitalised adults, limiting the ability of clinicians and healthcare managers to make informed, cost-effective treatment decisions. Further economic evaluations are needed and should be considered as a routine component of future research.
Publisher: Oxford University Press (OUP)
Date: 14-12-2016
Abstract: effective strategies are required to support the nutritional status of patients. to evaluate a foodservice nutrition intervention on a range of participant outcomes and estimate its cost. parallel controlled pilot study. subacute hospital ward. all consecutively admitted adult patients were eligible for recruitment under waiver of consent. the intervention was a modified hospital menu developed by substituting standard items with higher energy options. The control was the standard menu. All participants received usual multidisciplinary care. Outcomes were change in weight and hand grip strength (HGS) between admission and day 14 and energy and protein intake and patient satisfaction with the foodservice at day 14. The additional cost of the intervention was also estimated. the median (interquartile range) age of participants (n = 122) was 83 (75-87) years and length of stay was 19 (11-32) days. One-third (38.5%) were malnourished at admission. There was no difference in mean (SD) HGS change (1.7 (5.1) versus 1.4 (5.8) kg, P = 0.798) or weight change (-0.55 (3.43) versus 0.26 (3.33) %, P = 0.338) between the intervention and control groups, respectively. The intervention group had significantly higher mean (SD) intake of energy (132 (38) versus 105 (34) kJ/kg/day, P = 0.003) and protein (1.4 (0.6) versus 1.1 (0.4) g protein/kg/day, P = 0.035). Both groups were satisfied with the foodservice. The additional cost was £4.15 articipant/day. in this pilot, the intervention improved intake and may be a useful strategy to address malnutrition. Further consideration of clinical and cost implications is required in a fully powered study.
Publisher: Wiley
Date: 04-07-2022
DOI: 10.1111/JHN.12928
Abstract: To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food-related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting. Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool. Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2-week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting and analysing data from a food waste audit. This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.
Publisher: Cambridge University Press (CUP)
Date: 2018
Publisher: Wiley
Date: 16-11-2019
DOI: 10.1111/IJFS.13979
Publisher: Springer Science and Business Media LLC
Date: 26-08-2012
DOI: 10.1007/S11695-012-0741-X
Abstract: There is a paucity of evidence-based dietary management guidelines for patients post-laparoscopic adjustable gastric banding, including no consensus recommendations for macronutrient intake. We examined the macronutrient intake across a multi-centre cohort of post-bariatric surgery patients and compared these intakes to post-bariatric surgery and population-based dietary guidelines. Two hundred and fifteen patients from three bariatric surgery centres in Melbourne, Australia were invited to complete a validated Food Frequency Questionnaire 12 months post-operatively. Energy intakes of the 52 participants ranged from 1,140 to 13,200 kJ/day, with an average of 4,890 kJ/day (±2,360 kJ/day). Many patients did not meet minimum population recommendations for macronutrients. The average fibre intake was only 14 g/day (compared to the recommendations of 25 g for women and 30 g for men). The average diet 1 year post-operatively was 36% total fat compared to the recommendations of 20-25%, with 14% of intake from saturated fat. Patients' dietary intakes vary significantly 1 year post-laparoscopic adjustable band surgery, with many patients not meeting recommendations. These results suggest that patients decrease their total energy intake however, eating habits may not improve as they consume a diet high in saturated fat. It is recommended that all patients receive dietary education about diet quality post-laparoscopic adjustable gastric band surgery to assist them in improving their diet quality as well as quantity for optimal health and weight loss. Specific international guidelines for nutrient intakes for people undergoing bariatric surgery are needed.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2020
Publisher: Wiley
Date: 06-2012
Publisher: SAGE Publications
Date: 09-1999
DOI: 10.1177/030802269906200904
Abstract: This study quantified the food skills of people with a mental illness living in hospital-based care and the community using the Functional Needs Assessment — Nutritional Management Program (Dombrowski 1990). There were clear and marked food skills deficits among people living in hospital-based care. There were no significant differences between the food skills of male and female participants. The deficits that were identified may place patients at nutritional risk if they are moved into community accommodation without appropriate support mechanisms for the provision of food. Recommendations are made for intervention through the implementation of food skills training and incidental learning.
Publisher: Informa UK Limited
Date: 12-02-2013
DOI: 10.3109/17549507.2013.763290
Abstract: A shortage of clinical education placements for allied health students internationally has led to the need to explore innovative models of clinical education. The collaborative model where one clinical educator supervises two or more students completing a clinical placement concurrently is one model enabling expansion of student placements. The aims of this review were to investigate advantages and disadvantages of the collaborative model and to explore its implementation across allied health. A systematic search of the literature was conducted using three electronic databases (CINAHL, Medline, and Embase). Two independent reviewers evaluated studies for methodological quality. Seventeen studies met inclusion/exclusion criteria. Advantages and disadvantages identified were consistent across disciplines. A key advantage of the model was the opportunity afforded for peer learning, whilst a frequently reported disadvantage was reduced time for in idual supervision of students. The methodological quality of many included studies was poor, impacting on interpretation of the evidence base. Insufficient data were provided on how the model was implemented across studies. There is a need for high quality research to guide implementation of this model across a wider range of allied health disciplines and to determine educational outcomes using reliable and validated measures.
Publisher: Emerald
Date: 08-02-2016
DOI: 10.1108/IJHCQA-04-2015-0051
Abstract: – Most patients in developed countries solely depend on the hospital menu to order their food. The provision of menu choices to patients differs between facilities. The purpose of this paper is to determine which strategies that provide menu choices to patients are effective in improving clinical and non-clinical outcomes in hospital. – Five databases were searched to identify relevant publications. Prospective research published in English with the menu as the primary intervention was included. Study eligibility was determined and risk of bias assessed. Outcome data were combined narratively due to absence of homogeneous study design and outcomes. – Of the 2,201 records screened, six studies met inclusion criteria. Standardised menu formatting and the spoken menu system were found to improve meal tray accuracy. The spoken menu and computerised interactive menu selector system enhanced aspects of patient satisfaction without cost increases. Descriptive menus may increase food consumption. Branding food items was not well supported by patients. One study rated positively for study quality with the remaining five studies receiving neutral quality ratings. – The small number of studies conducted on each intervention and the quality of the evidence made it difficult to establish a solid evidence base around providing menu choices to patients. Further research is needed on menu ordering systems, including spoken and visual menus, to determine their impact on outcomes in hospital. – This review is first to examine the effectiveness of menu interventions in hospital. Hospital foodservice departments should consider these findings when reviewing local systems.
Publisher: Wiley
Date: 15-05-2009
Publisher: Wiley
Date: 07-06-2018
DOI: 10.1111/JAN.13693
Abstract: To evaluate the implementation of Protected Mealtimes and contrast the findings with implementation fidelity. Protected Mealtimes is a systems approach developed to address the issue of malnutrition in hospitalized patients. Previous studies have used a pre--post study design, with no high-quality trials previously undertaken to measure the effect of the intervention. A prospective, stepped-wedge cluster randomized controlled trial was undertaken October-November 2015. This process evaluation was conducted using qualitative and quantitative methods to explain discrepancies between expected and observed clinical trial outcomes. Qualitative data were collected using focus groups with the healthcare team and contrasted with fidelity data. Quantitative data were collected using attendance lists, audits and observations and analysed descriptively. Concept-driven coding was undertaken using a framework derived from studies citing the Theoretical Domains Framework. Staff training in the trial protocol was viewed positively, however, not all staff attended. Staff were generally enthusiastic about Protected Mealtimes with many programme aspects successfully implemented. Limited staffing resources, particularly of nursing staff, hindered implementation. The presence of trial observers affected staff morale by increasing feelings of stress and anxiety. Process data allowed challenges for the implementation of Protected Mealtimes under clinical trial conditions to be described. Given our inability to implement the trial protocol fully due to the complexity of the mealtime environment and the lack of efficacy on nutritional intake, alternative approaches should be considered to resolve the problem of hospital malnutrition.
Publisher: Wiley
Date: 29-03-2017
Publisher: Wiley
Date: 27-01-2020
DOI: 10.1111/JHN.12734
Abstract: Change promotes quality in healthcare, yet adopting change can be challenging. Understanding how change in nutrition care is adopted may support better design and implementation of interventions that aim to address inadequate food intake in hospital. The present study followed the process of change in a healthcare organisation, exploring staff attitudes, beliefs and experiences of the implementation of a mealtime intervention. In total, 103 h of fieldwork were conducted in this longitudinal ethnographic study over a 4-month period. Over 170 staff participated, with data captured using observation, interviews and focus groups. Data were analysed using an inductive, thematic approach, informed by implementation theory. Attitudes and experiences of change in nutrition care are described by three themes: (i) staff recognised the inevitability of change (ii) staff cooperated with the intervention, recognising potential value in the intervention to support patient care, where increased awareness of their mealtime behaviours supported adopting practice changes and (iii) some staff were able to reflect on their practice after implementing the intervention, whereas others could not. A model illustrating the interconnectedness of factors influencing implementation emerged from the research, guiding future nutrition care intervention design and supporting change. The requirement to address the underlying perceptions of staff about the need to change should not be underestimated. Increased efforts to market the change message to specific staff groups and physical behavioural reinforcement strategies are needed. Nutrition care in the future should focus on helping staff feel positive about making practice changes.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1093/AJCN/NQZ200
Publisher: Springer Science and Business Media LLC
Date: 02-03-2016
DOI: 10.1038/EJCN.2016.2
Abstract: Nutritional status influences patients' clinical and functional outcomes. The aims were to identify changes in nutritional state during subacute care and associated participant characteristics. A longitudinal study was undertaken with consecutive patients admitted to subacute care wards during a 3-month period. Participants were recruited under a waiver of consent to reflect the usual demographic. Change in classification (malnourished, at risk of malnutrition, well nourished) of the full Mini Nutritional Assessment (full MNA) between admission and discharge was the primary outcome. Weight (kg), mid-arm and calf circumference (cm) change were secondary outcomes. Hand grip strength (kg) and fat-free mass (kg) (assessed using bioelectrical impedance analysis) were measured for a consenting subgroup. Participants (n=248, 36.7% male) had a median age of 80 years and a length of stay of 17 days. On admission, 29.1% were classified as malnourished. By discharge, nutritional classification remained stable for 62.0% of participants (n=132), declined for 10.3% (n=22) and improved for 27.7% (n=59, including 52.5% malnourished on admission). Impaired cognition (odds ratio (OR)=0.169, P=0.002) and higher full MNA score at admission (OR=0.870, P=0.001) reduced odds of improvement in full MNA. There was no change in hand grip strength (n=46), but there was a decline in mean fat-free mass (-1.1 kg, 95% confidence interval: -0.1 to -2.2 kg, P=0.043, n=24). Multidisciplinary care supports the nutritional state of most patients admitted to subacute care. Those with cognitive impairments or at risk of malnutrition were less likely to demonstrate improvement and may benefit from more intensive or tailored nutritional care.
Publisher: Wiley
Date: 13-02-2022
DOI: 10.1002/JCSM.12928
Abstract: Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health‐related quality of life (HRQOL) is less established. This systematic review and meta‐analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta‐analysis to investigate cross‐sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies ( n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [ n = 985 from seven studies, standardized mean difference −0.27, 95% confidence interval (CI) −0.40 to −0.14, P 0.0001], and poorer physical functioning domain HRQOL scores ( n = 507 from five studies, standardized mean difference −0.40, 95% CI −0.74 to −0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P 0.05). Five studies examined the cross‐sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non‐linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.
Publisher: BMJ
Date: 10-06-2017
Publisher: MDPI AG
Date: 27-02-2023
Abstract: Background: Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This study investigated interrelationships between nutritional intake and clinical outcomes in hospitalised adult oncology patients. Methods: Estimated nutrition intake data were obtained from patients admitted to a 117-bed tertiary cancer centre during May–July 2022. Clinical healthcare data, including length of stay (LOS) and 30-day hospital readmissions, were obtained from patient medical records. Statistical analysis, including multivariable regression analysis, assessed whether poor nutritional intake was predictive of LOS and readmissions. Results: No relationships between nutritional intake and clinical outcomes were evident. Patients at risk of malnutrition had lower mean daily energy (−898.9 kJ, p = 0.001) and protein (−10.34 g, p = 0.015) intakes. Increased malnutrition risk at admission prolonged LOS (1.33 days, p = 0.008). Hospital readmission rates were 20.2%, and associated with age (r = −0.133, p = 0.015), presence of metastases (r = 0.125, p = 0.02) and longer LOS (1.34 days, r = 0.145, p = 0.02). Sarcoma (43.5%), gynaecological (36.8%) and lung (40.0%) cancers had the highest readmission rates. Conclusions: Despite research showing the benefits of nutritional intake during hospitalisation, evidence continues to emerge on the relationship between nutritional intake and LOS and readmissions that may be confounded by malnutrition risk and cancer diagnosis.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH15180
Abstract: Objective The aim of the present study was to determine whether there is an association between having research culture in a health service and better organisational performance. Methods Using systematic review methods, databases were searched, inclusion criteria applied and study quality appraised. Data were extracted from selected studies and the results were synthesised descriptively. Results Eight studies were selected for review. Five studies compared health services with high versus low levels of research activity among the workforce. Three studies evaluated the effect of specific interventions focused on the health workforce. All studies reported a positive association between research activity and organisational performance. Improved organisational performance included lower patient mortality rates (two of two studies), higher levels of patient satisfaction (one of one study), reduced staff turnover (two of two studies), improved staff satisfaction (one of two studies) and improved organisational efficiency (four of five studies). Conclusions A stronger research culture appears to be associated with benefits to patients, staff and the organisation. What is known about this topic? Research investment in the health workforce can increase research productivity of the health workforce. In addition, investment in clinical research can lead to positive health outcomes. However, it is not known whether a positive research culture among the health workforce is associated with improved organisational performance. What does this paper add? The present systematic review of the literature provides evidence that a positive research culture and interventions directed at the health workforce are associated with patient, staff and organisational benefits. What are the implications for practitioners? For health service managers and policy makers, one interpretation of the results could be to provide support for initiatives directed at the health workforce to increase a research culture in health services. However, because association does not imply causation, managers need to interpret the results with caution and evaluate the effect of any initiatives to increase the research culture of the health workforce on the performance of their organisation.
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/JOCN.14318
Abstract: To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. A qualitative, ethnographic approach. Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and the importance of nutrition. The working relationship between hospital staff, volunteers and visitors should be strengthened to improve nutritional care.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JAND.2018.06.002
Abstract: Ethnography is a qualitative research approach used to learn about people and their culture. There is a need to explore the application and use of ethnographic methodology in nutrition and dietetics research to inform future research and practice. Our aim was to examine the extent, range, nature, and contribution of ethnographic methodology in nutrition and dietetics research. Eight electronic databases were searched using a defined search strategy until November 2017. No restrictions were placed on language, date, or study design of original research. Two authors independently assessed titles and abstracts, then full-text records, against inclusion criteria. Hand-searching of reviews identified in the database search was undertaken. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Data were described narratively. A total of 2,185 records were identified, with 92 studies from public health nutrition (n=72), clinical nutrition (n=13), and foodservice (n=7) practice areas meeting inclusion criteria. Common research areas included infant/child feeding, food choice, diabetes, nutrition in schools and food insecurity. In addition to observation, frequently reported data collection techniques were interview (n=85), focus groups (n=17), and document analysis (n=10). Ethnographic research was most often reported from North America (n=31), Europe (n=16), and Australia/Oceania (n=13). This research approach was shown to inform dietetic research and practice by illuminating sociocultural factors that influence dietary beliefs and practices, practitioner training opportunities, evaluating nutrition education methods, informing programs and interventions, identifying nutrition policy and guideline focus areas, and the need for new approaches and communication strategies. Ethnography can increase understanding of complex food and nutrition-related health issues and their contributing factors across public health nutrition, foodservice, and clinical dietetic practice. It can be used to explain health inequalities, direct policy, and inform more effective intervention design and delivery. Wider uptake of this research approach as a stand-alone or complementary study design will advance efforts to improve health and wellbeing through food and nutrition.
Publisher: Wiley
Date: 11-09-2015
DOI: 10.1111/NEP.12500
Abstract: Dietary apps for mobile technology are becoming increasingly available and can assist in recording food and fluid intake for nutrition assessment or monitoring. Patients with chronic renal disease, particularly those on dialysis, are required to make significant dietary changes. This study systematically reviews the current literature to assess whether dietary mobile apps improve dietary intake and clinical outcomes in the renal population, specifically those with chronic kidney disease levels 3-5, including dialysis. A systematic search of Medline Complete, CINAHL, Embase, PsycINFO and the Cochrane Library was performed and supplemented by manual searches of citation and reference lists. Of the 712 studies considered, five were eligible for inclusion in this review. The quality of each included study was assessed using a Quality Criteria Checklist for Primary Research. Among five studies (two randomised controlled trials (RCTs) and three case studies/reports), none found significant changes in nutrient intake, biochemical markers or intradialytic weight gain, through the use of dietary mobile apps. The included studies show potential for clinical benefits of mobile app interventions in a renal population. However, there is a need for additional rigorous trials to demonstrate if there is a clinical benefit of mobile app interventions in this population.
Publisher: Wiley
Date: 19-12-2019
Abstract: The number of advanced practice roles in the Australian health-care system is growing alongside contemporary health-care reforms. The present study aimed to evaluate the impact of introducing novel advanced practice dietitian roles in gastrostomy tube (g-tube) management and develop a competency framework for progressing opportunities in dietetics practice and policy. A questionnaire was distributed to service lead dietitians at six participating health-care networks at the completion of a dedicated advanced practice funding grant, and at 12-month follow up. Service changes (e.g. number of dietitians credentialed, service and adverse events, change in patient waiting times and staff satisfaction), enablers and barriers for the implementation of the novel roles (including pre-, during, and post-implementation), and clinical costing estimates to measure the financial impact on the health system were investigated. Participant feedback was also used to synthesise the development of an advanced scope of practice pathway to competency. Responses were received from all participating health-care networks. Five out of six sites successfully implemented an advanced practice role in g-tube management, with conservative health system savings estimated at $185 000. Ten dietitians were credentialed, with a further seven trainees in progress. Over 200 service events were recorded, including those erted from other health professionals. Enabling factors for successful introduction included strong executive and stakeholder support, resources provided by grant funding, and established credentialing governance committees. Barriers included recruitment and governance processes. Opportunities exist for further expansion of advanced and extended practice roles for dietitians to meet future health-care demands.
Publisher: Springer Science and Business Media LLC
Date: 17-05-2021
DOI: 10.1186/S40798-021-00323-9
Abstract: Ageing is associated with a decline in skeletal muscle mass and function (strength and power), known as sarcopenia. Inadequate dietary protein and inactivity have been shown to accelerate sarcopenia outcomes, occurring at different rates in males and females. Regardless, active older adults who often exceed the exercise guidelines still show signs of sarcopenia. This study aimed to explore the link between age, physical activity, protein intake, and biological sex with skeletal muscle mass, strength, power, and physical capacity erformance in active older adults. Fifty-four active older adults were recruited from this trial and grouped according to age (middle aged: 50–59 years, and older age: ≥ 60 years), exercise volume (low: ≥ 90–149 min/week, moderate: ≥ 150–299 min/week, and high: ≥ 300 min/week), protein intake (low: 0.8 g/kg body mass (BM), moderate: ≥ 0.8–1.19g /kg BM, and high: ≥ 1.2 g/kg BM), and biological sex (males and females). Skeletal muscle and fat mass (dual X-ray absorptiometry), strength (1-repetition maximum using leg press, chest press, lateral pull down, and hand grip), power (counter movement jump), and general fitness (cardiorespiratory capacity and gait speed) were assessed. Data were grouped based on variables, and a general linear model (ANCOVA) or an independent t test was used to determine between group differences. Fifty three of the total participants’ data were analysed. The middle-aged group had 18%, 11%, and 10% higher leg press, chest press, and lateral pull down, respectively, compared to the older-aged group ( p .05). There were no significant differences between different levels of training volume and any of the outcomes. Higher protein intakes were associated with significantly less body fat mass ( p = .005) and a trend towards a higher leg press ( p = .053) and higher relative power (W/kg) ( p = .056) compared with the moderate and low protein intake groups. Significant differences based on biological sex were observed for all outcomes except for gait speed ( p = .611) and cardiorespiratory fitness ( p = .147). Contributions of age, physical activity, daily protein intake, and biological sex can explain the in idual variation in outcomes related to changes in body composition, strength, power, and/or cardiorespiratory fitness in a cohort of active older adults. The preprint version of this work is available on Research Square: rticle/rs-51873/v1 . This trial is registered in the ANZCTR.org.au, no. ACTRN12618001088235 ( www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375286 ).
Publisher: Informa UK Limited
Date: 26-11-2019
DOI: 10.1080/21551197.2019.1691108
Abstract: Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group 0.56 ± 2.76 kg, sHEHP group,
Publisher: S. Karger AG
Date: 2023
DOI: 10.1159/000528872
Abstract: b i Introduction: /i /b The life expectancy of older adults continues to increase however, knowledge regarding their total energy requirements is lacking. This study aimed to compare the total energy expenditure (TEE) of older adults ≥80 years measured using doubly labelled water (DLW), with estimated TEE. The hypothesis was that the Mifflin, Ikeda, and Livingston equations will more closely estimate energy requirements than the commonly used Schofield equation. b i Methods: /i /b Resting metabolic rate (RMR) and TEE were measured using the reference methods of indirect calorimetry and DLW, respectively. Bland-Altman plots compared measured RMR and TEE with predicted RMR using equations (Mifflin, Ikeda, Livingston, Schofield) and predicted TEE (predicted RMR i × /i physical activity level). b i Results: /i /b Twenty-one older adults (age range 80.7–90.1 years, BMI 26.1 ± 5.5 kg/m sup /sup ) were included. The Schofield equation demonstrated the greatest bias from measured RMR, overestimating approximately up to double the mean difference (865 ± 662 kJ/day) compared with the three other equations. The Schofield equation exhibited the greatest bias (overestimation of 641 ± 1,066 kJ/day) compared with measured TEE. The other three equations underestimated TEE, with the least bias from Ikeda (37 ± 1,103 kJ/day), followed by Livingston (251 ± 1,108 kJ/day), and Mifflin (354 ± 1,140 kJ/day). Data are mean ± SD. b i Conclusions: /i /b In older adults ≥80 years, the Ikeda, Mifflin, and Livingston equations provide closer estimates of TEE than the widely used Schofield equation. The development of nutrition guidelines therefore should consider the utilization of equations which more accurately reflect age-specific requirements.
Publisher: Wiley
Date: 08-06-2022
Abstract: Meeting the nutritional needs and foodservice expectations of hospital inpatients is challenging. This study aimed to determine whether adults receiving specialist inpatient mental health services meet their energy and protein requirements and are satisfied with the foodservice. An observational study of adults admitted to three specialist inpatient mental health services within a large health service. Energy and protein intake were determined over 24 h via observation, and nutritional requirements were estimated using standard procedures. Validated questionnaires were used to assess satisfaction with the lunch meal, elements of the foodservice system, and overall foodservice satisfaction. Among 74 participants, the median (IQR) energy intake (6954 [5111-10 250]kJ/day) was less than estimated requirements (8607 [7319-9951]kJ/day), whilst protein intake (85 [62-120]g/day) exceeded requirements (59 [46-70]g/day). Food from external sources was consumed by 50% of participants. Satisfaction surveys found vegetables were rated more poorly than the meat or carbohydrate portion of the meal, food quality was rated lowest compared with meal service, staffing and physical environment. The majority of participants (89%) rated their last meal as average, with the remainder (11%) rating it as poor. There are opportunities to improve the meal and foodservice experience for this patient group to meet their nutritional requirements and expectations. Investment in quality food and menus that are appropriate for the demographics, exploration of the most appropriate foodservice system, and adequate dietetic resourcing are needed to improve nutrition care within specialist inpatient mental health services.
Publisher: Wiley
Date: 28-03-2019
DOI: 10.1111/APT.15199
Publisher: Wiley
Date: 04-2017
Abstract: Implementation of an intervention can result in a discrepancy between what was planned and what is delivered, affecting outcomes for recipients. The aim was to explore, from the perspective of hospital foodservice staff, their experiences delivering a nutrition intervention and the barriers and enablers to its implementation. A process evaluation of a pilot study was undertaken using qualitative description. A purposive s le (n = 15) of hospital foodservice supervisors and foodservice assistants responsible for delivering a higher energy menu to hospital patients participated in focus groups and semistructured interviews. Theoretical frameworks of behaviour underpinned the method. Content analysis elicited factors (sub-themes) influencing foodservice staff's capability, opportunity and motivation to provide the nutrition intervention. Thematic analysis (by two independent researchers) further explored factors (themes) related to the process of the intervention's implementation. Five key themes (and 15 sub-themes) explained factors effecting implementation of the nutrition intervention. Aspects of the foodservice environment and patients' resistance were barriers to implementation and perceived sustainability. Teamwork, problem solving, leadership and job satisfaction were enablers. There was an opportunity to optimise training and feedback. Characteristics of foodservice staff, including their: knowledge, beliefs and perceptions of diet, health and their job role, had the potential to influence their behaviours and decision making. A number of interacting factors influenced foodservice staff's delivery of a higher energy menu as planned. Addressing the challenges of time, foodservice structure, patients' resistance, gaps in knowledge and misconceptions among foodservice staff may enhance similar nutrition interventions in the future.
Publisher: MDPI AG
Date: 12-01-2023
DOI: 10.3390/NU15020400
Abstract: Background: Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This review investigated the interrelationships between dietary intakes, hospital readmissions and length of stay in hospitalised adult oncology patients. Methodology: Three databases, MEDLINE, Web of Science and PubMed were searched for relevant publications from January 2000 to the end of August 2022. Results: Eleven studies investigating the effects of dietary intakes on length of stay (LOS) and hospital readmissions in cohorts of hospitalised patients that included oncology patients were identified. Heterogenous study design, nutritional interventions and study populations limited comparisons however, a meta-analysis of two randomised controlled trials comparing dietary interventions in mixed patient cohorts including oncology patients showed no effect on LOS: mean difference −0.08 (95% confidence interval −0.64–0.49) days (p = 0.79). Conclusions: Despite research showing the benefits of nutritional intake during hospitalisation, evidence is emerging that the relationship between intakes, LOS and hospital readmissions may be confounded by nutritional status and cancer diagnosis.
Publisher: Wiley
Date: 27-12-2018
DOI: 10.1111/APT.15079
Abstract: Despite the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) for patients with irritable bowel syndrome, many questions remain unanswered with respect to its clinical implementation. To review literature to identify, synthesise, and provide direction for future research in the implementation and evaluation of the low FODMAP diet. Bibliographical searches were performed in Ovid Medline, CINAHL, Scopus and PubMed from database commencement until September 2018, with search terms focused on the population (irritable bowel syndrome) and intervention of interest (FODMAP). Predictors of response to a low FODMAP diet remain under investigation, with preliminary data supporting faecal microbiota or faecal volatile organic compound profiling. Training of clinicians, and standards for the education of patients about the phases of a low FODMAP diet, as well as the role of Apps, require formal evaluation. There are limited data on the longer term efficacy and safety of the low FODMAP diet with respect to sustained symptom control, effect on quality of life and healthcare utilisation, nutritional adequacy, precipitation of disordered eating behaviours, effects on faecal microbiota and metabolomic markers, and subsequent translation to clinical effects. Many gaps in implementation of the low FODMAP diet in clinical practice, as well as long-term safety and efficacy, remain for further investigation.
Publisher: BMJ
Date: 06-2021
DOI: 10.1136/BMJOPEN-2020-047970
Abstract: Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation. An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews. Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars. ACTRN12619000936123.
Publisher: Wiley
Date: 19-01-2023
DOI: 10.1111/JHN.13131
Abstract: Public institutions have the opportunity to implement environmental sustainability policies through leveraging their buying potential. Given the role of hospitals within the food system, the implementation of sustainable initiatives into hospital foodservices is a priority. Compared to conventional agricultural methods, organic food production uses more sustainable practices and warrants consideration for utilisation in hospitals. This systematic review aimed to synthesise the published literature to identify benefits, limitations and implementation issues regarding the use of organic foods in hospital foodservice settings. The review protocol was prospectively published (PROSPERO registration CRD42022322245) and reported consistent with Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. A systematic search of four databases was undertaken for papers published from January 2000 to March 2022 key outcome data were extracted and synthesised. Study quality was assessed using the Quality Criteria Checklist for Primary Research or the Critical Appraisal Skills Programme checklist. After review of 4102 titles/abstracts and 113 full‐text papers, the final library comprised 10 papers of moderate to high quality. The implementation of organic foods increased quality in addition to environmental sustainability improvements. The price premium, additional production requirements, change to kitchen routines and concerns with food quality and security of supply were reported as barriers. Government targets for increasing organic food, organisational support, and staff knowledge and training supported implementation. This review identified opportunities for the implementation of organic foods into hospital foodservices, but there are numerous barriers to be overcome through strategies including organisational support and staff training.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15060
Abstract: Protected mealtimes is an initiative to support increased nutritional intake for all hospitalised patients, particularly those who are malnourished. The increased focus on maximising independence of patients in the subacute setting may provide a supportive environment for implementing these strategies. The aim of the present study was to gain insight into subacute ward practices at mealtimes under usual conditions (i.e. at baseline) where no protected mealtimes policy was implemented. Participants were patients aged ≥65 years recruited from subacute care facilities at a large healthcare network in Victoria, Australia. Participants were observed at mealtimes and mid meals (i.e. morning tea, afternoon tea and supper) to determine daily energy and protein intake, provision of mealtime assistance and mealtime interruptions. Almost all participants received assistance when it was needed, with positive and negative interruptions experienced by 56.2% and 76.2% of participants, respectively. There was an energy deficit of approximately 2 MJ per day between average intake and estimated requirements. In conclusion, mealtime practices were suboptimal, with particularly high rates of negative interruptions. Protected mealtimes is one strategy that may improve the mealtime environment to support patients’ dietary intake. Prospective studies are needed to evaluate its implementation and effects. What is known about this topic? The mealtime environment on a hospital ward may influence the nutritional intake of patients. Protected mealtimes is a systems approach that aims to minimise negative interruptions and promote positive interruptions to enhance the nutritional intake and nutritional status of patients. Whilst the approach has been widely implemented, further evaluation of its fidelity and effects is required. What does this paper add? This observational research has determined the nutritional intake, provision of assistance and interruptions at mealtimes experienced by a cohort of subacute care patients under usual care conditions. An energy deficit of approximately 2MJ below estimated requirements was identified. Half of the participants received positive interruptions and the majority of participants requiring assistance received it, however the prevalence of negative interruptions was high. This pilot study has enabled a fully powered prospective study to be designed, exploring the implementation of protected mealtimes and its effects on nutritional intake of patients in the subacute setting. What are the implications for practitioners? The energy deficit that exists for patients in subacute care may lead to nutritional decline, and longer lengths of stay. There are opportunities to improve ward practices at mealtimes in the subacute setting to focus on nutritional care.
Publisher: Wiley
Date: 06-10-2020
DOI: 10.1111/NHS.12777
Publisher: Public Library of Science (PLoS)
Date: 27-04-2023
DOI: 10.1371/JOURNAL.PONE.0277760
Abstract: Autologous stem cell transplant is a common procedure for people with haematological malignancies. While effective at improving survival, autologous stem cell transplant recipients may have a lengthy hospital admission and experience debilitating side-effects such as fatigue, pain and deconditioning that may prolong recovery. Prehabilitation comprising exercise and nutrition intervention before stem cell transplant aims to optimise physical capacity before the procedure to enhance functional recovery after transplant. However, few studies have evaluated prehabilitation in this setting. We aim to explore preliminary efficacy of improving physical capacity of prehabilitation for people undergoing autologous stem cell transplant. The PIRATE study is a single-blinded, parallel two-armed pilot randomised trial of multidisciplinary prehabilitation delivered prior to autologous stem cell transplantation. Twenty-two patients with haematological malignancy waitlisted for transplant will be recruited from a tertiary haematology unit. The intervention will include up to 8 weeks of twice-weekly, supervised tailored exercise and fortnightly nutrition education delivered via phone, in the lead up to autologous stem cell transplant. Blinded assessments will be completed at week 13, approximately 4 weeks after transplant and health service measures collected at week 25 approximately 12 weeks after transplant. The primary outcome is to assess changes in physical capacity using the 6-minute walk test. Secondary measures are time to engraftment, C-reactive protein, physical activity (accelerometer), grip strength, health-related quality of life (EORTC QLQ-C30 and HDC29 supplement), self-efficacy and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, emergency department presentations and urgent symptom clinic presentation at will also be recorded. This trial will inform design of a future definitive randomised controlled trial and implementation of prehabilitation for people receiving autologous stem cell transplant by providing data on efficacy and safety. The PIRATE Trial has been approved by the Eastern Health Human Research Ethics Committee (E20/003/61055) and is funded by the Eastern Health Foundation. This trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12620000496910 . Registered April 20, 2020.
Publisher: Wiley
Date: 09-05-2023
DOI: 10.1111/JHN.13178
Abstract: Local food procurement by hospitals is gaining traction as governments and advocacy groups seek to influence food systems and strengthen local communities, but there is little empirical evidence as to its practical application or efficacy. The aims of this review were to describe the extent, range and nature of local food procurement models in healthcare foodservices, and to understand the barriers and enablers to implementation, including from the perspective of stakeholders across the supply chain. A scoping review was conducted following the protocol published in the Open Science Framework Registration (DOI: 10.17605/OSF.IO/T3AX2). Five electronic databases were searched for the following concepts: ‘hospital foodservice’, ‘local food procurement practices’, ‘the extent, range and nature’ and/or ‘the barriers and enablers of procurement’. Eligible peer‐reviewed original research published in English from the year 2000 was included following a two‐step selection process. The final library included nine studies. Most studies (7 of 9) were from the United States. Three studies used survey methods and reported high rates (58%–91%) of US hospital participation in local food procurement. Studies offered minimal description of local procurement models, but two models, conventional (‘on‐contract’) or off‐contract, were typically used. Barriers to local food procurement included restricted access to suitable local food supply, limited kitchen resources and inadequate technology to trace local food purchase thereby limiting evaluation capabilities. Enablers included organisational support, passionate ch ions and opportunistic, incremental change. There is a paucity of peer‐reviewed studies describing local food procurement by hospitals. Details of local food procurement models were generally lacking: categorisable as either purchases made ‘on‐contract’ via conventional means or ‘off‐contract’. If hospital foodservices are to increase their local food procurement, they require access to a suitable, reliable and traceable supply, that acknowledges their complexity and budgetary constraints.
Publisher: Wiley
Date: 26-01-2021
DOI: 10.1111/NHS.12812
Abstract: Communal dining offers multiple benefits for hospital patients, yet dining rooms may be underutilized in practice. This study aimed to understand and explore staffs' perspectives and experiences of communal dining in subacute care, and the impacts on staff mealtime practice. Using qualitative, ethnographic methodology, 94 hours of fieldwork were conducted across two subacute care wards. Participants were staff involved in nutrition care or present on the ward at mealtimes. Ninety‐one semistructured and ethnographic interviews were conducted with 59 staff, and 54 episodes of observation captured more than 190 staff. Interviews and field notes were thematically analyzed using an inductive approach. Three themes were identified: (i) benefits to patients (ii) logistical and practical challenges and (iii) supportive cultural factors. While staff recognized how communal dining benefited patients, logistical and practical challenges impacted their ability to facilitate it in practice. Healthcare organizations seeking to embed communal dining into the mealtime routine should recognize that clear delineation of staff roles and responsibilities, and cultural change involving normalization, setting expectations, and collective advocacy may be needed to optimize benefits for patients.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Wiley
Date: 10-05-2016
DOI: 10.1111/NBU.12199
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
DOI: 10.1002/CHP.21255
Abstract: Evidence-based practice (EBP) is a key principle in the delivery of effective and high-quality health care. Existing research suggests that allied health professionals are generally supportive of EBP but rarely participate in activities associated with EBP. This mixed-method study used 8 focus groups of allied health professionals and managers and a questionnaire of all participants to explore the attitudes and barriers to EBP in a large metropolitan health service. Qualitative data were analyzed using a thematic analysis of focus group transcriptions. Questionnaire data were analyzed descriptively. Fifty clinicians and 10 managers across 7 allied health disciplines participated in the study. The questionnaire identified that clinicians have a positive attitude but low participation in EBP. Qualitative data revealed that EBP was not highly valued by clinicians and managers or viewed as a core component of clinical care, with activities directly related to maintaining patient flow viewed as higher priorities. Lack of skills and resources and difficulty associated with implementing evidence into practice were further barriers. Achieving higher uptake of EBP among allied health clinicians requires a cultural shift, placing higher value on these activities despite the challenging context of constant pressures to increase patient flow. Addressing EBP through small group projects rather than considering it to be an in idual responsibility may be more acceptable to both clinicians and managers, with added benefits of peer support for both evaluating evidence and translation into practice.
Publisher: MDPI AG
Date: 27-02-2017
DOI: 10.3390/NU9030204
Publisher: Wiley
Date: 09-11-2018
DOI: 10.1111/JAN.13477
Abstract: To explore and understand patterns of mealtime culture, environment and social practice from the perspective of staff, volunteers and visitors on the hospital ward. Inadequate food intake is a common and complex problem in hospital and can lead to malnutrition. Mealtime interventions have been implemented to address this problem with limited success. A better understanding of mealtime environment and practice is needed to ascertain which interventions are more likely to be effective in addressing inadequate food intake in hospital. A qualitative, ethnographic approach was used to promote a comprehensive understanding of mealtime environment and practice. Sixty-seven hours of fieldwork was conducted August-October 2015. More than 150 participants were observed and 61 unique participants were interviewed in 75 interviews. Data analysis followed an inductive, thematic approach, informed by systems and complexity theory. Themes of "patient centredness" and "system" and their disharmonious interrelationship emerged. Staff, volunteers and visitors strive for patient centredness at mealtimes. The routine and structured nature of the meal and care systems was constantly in tension with providing patients the care they needed. The findings of this study expose the challenges associated with maintaining patient centredness at mealtimes in complex healthcare and foodservice systems. This facilitates a better understanding of why inadequate food intake is difficult to address in the hospital setting and highlights the need to support strategies that approach foodservice processes and nutritional care as complex and non-linear.
Publisher: Wiley
Date: 30-06-2021
DOI: 10.1111/AJAG.12977
Abstract: Weight loss is a primary manifestation of dementia. This review aimed to systematically synthesise the literature on total energy expenditure (TEE) in people with dementia. The protocol, registered with PROSPERO, was reported against PRISMA guidelines. Eligible studies investigated TEE in people with dementia. Six electronic databases and a supplementary Internet search identified relevant publications. Results were synthesised narratively. The final library considered the TEE of 358 participants. Two studies used the gold standard method of doubly labelled water (DLW) other studies used TEE measures validated against DLW. TEE varied considerably, from 6095 ± 1353 kJ to 9765 ± 2066 kJ. The TEE of community‐dwelling people with dementia (range 8430 ± 2250 kJ‐9765 ± 2066 kJ) was higher than in institutionalised groups (range 6095 ± 1353 kJ‐7619 ± 1827 kJ). New technologies will enable future research in this patient population to be less burdensome than those reliant on DLW measures. In planning future research, avoidance of selection bias and considering disease stage and movement are important considerations.
Publisher: Wiley
Date: 06-2012
Publisher: MDPI AG
Date: 11-11-2022
Abstract: Population ageing and climate change are issues of global concern. Subsequently, the need for healthy and sustainable food systems to meet the increasing demands for health and aged care is evident. This review aimed to systematically identify studies reporting new or innovative foods, drinks and snack products in health and aged care, and describe health and environmental sustainability considerations where reported. Methods were guided by the Joanna Briggs Institute guidelines for scoping reviews and reported against the PRISMA-ScR guidelines. Eligible studies were conducted in an inpatient healthcare setting or aged care facility where a new or innovative food, drink or snack product was evaluated with outcomes of product use, acceptability, cost, appropriateness for the population, and clinical or environmental sustainability outcomes in the last decade. Three databases were searched using a replicable strategy, with five publications of four studies included in the final library. Product innovations were led at the facility level and included testing dewaxed brown rice, talbinah, and an apple ear juice fibre solution. Results suggest that food industry suppliers are operating in parallel with foodservices within hospital and aged care. Future intersection would be transformative for both industry sectors.
Publisher: Wiley
Date: 24-08-2020
Abstract: This research aimed to use a consensus process to develop a framework and definition for nutrition and dietetic research, and to identify dietetic research priorities for Australia for the period 2020 to 2030. A three‐round Delphi process was selected to enable dietitians with demonstrated research expertise to contribute to the national priority development. All Fellows of the Dietitians Association of Australia, Advanced Accredited Practising Dietitians and research leaders were invited to participate (n = 84). The questionnaire was distributed electronically using a 7‐point Likert scale. Rounds 1 and 2 asked participants to comment on the proposed research framework, definition of dietetic research and to rate a set of priorities categorised within seven themes. Fields were available for comments for revisions to each section. Approval was considered when ≥70% of participants ranked priorities as Agree or Strongly agree . In Round 3, participants were asked to rank the resultant priorities within themes. Through this Delphi process, Australian dietitians with demonstrated expertise contributed to and confirmed a framework and definition for dietetic Research. A ranked list of 15 priorities within five themes for dietetic Research in Australia for the period 2020‐2030 was developed: Healthy ageing Vulnerable populations Food systems and health/nutrition promotion Informatics and evidence based practice and Achieving a balance between prevention and treatment approaches . It is anticipated that results will lead to the development of a research strategy to focus future dietetic research efforts, including the development of professional position papers as well as informing research competencies for dietetic education.
Publisher: Wiley
Date: 23-01-2023
Abstract: To measure the amount of different types of food and food packaging waste produced in hospital foodservice and estimate the cost associated with its disposal to landfill. A foodservice waste audit was conducted over 14 days in the kitchens of three hospitals (15 wards, 10 wards, 1 ward) operating a cook‐chill or cook‐freeze model with food made offsite. The amount (kg) of plate waste, trayline waste and packaging waste (rubbish and recycling) was weighed using scales and the number of spare trays and the food items on them were counted. Waste haulage fees ($AU0.18/kg) and price per spare tray item were used to calculate costs associated with waste. On average there was 502.1 kg/day of foodservice waste, consisting of 227.7 kg (45%) plate waste, 99.6 kg (20%) trayline waste and 174.8 kg (35%) packaging waste. The median number of spare trays was 171/day, with 224 items/day on them worth $214.10/day. Only 12% (20.4 kg/day) of packaging waste was recycled and the remaining 88% (154.4 kg/day) was sent to landfill along with food waste at two hospitals. Overall 347.3 kg/day was sent to landfill costing $62.51/day on waste haulage fees, amounting to 126.8 tonnes and $22 816.15 annually. A substantial amount of waste is generated in hospital foodservices, and sending waste to landfill is usual practice. Australia has a target to halve food waste by 2030 and to achieve this hospital foodservices must invest in systems proven to reduce waste, solutions recommended by policy advisors (e.g., waste auditing) and waste ersion strategies.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 20-11-2013
Publisher: Wiley
Date: 09-05-2014
DOI: 10.1111/JHN.12230
Abstract: Malnutrition occurs frequently among patients in rehabilitation, leading to poorer outcomes. Evidence of the effects of interventions to prevent or treat malnutrition is required to guide clinical practice in this setting. This systematic review aimed to determine the effect of oral nutrition interventions implemented in rehabilitation on nutritional and functional outcomes. Five databases were searched to identify relevant publications intervention trials of oral nutrition interventions (such as oral nutrition supplements, foodservice interventions, clinical care processes, enhanced eating environments) conducted with patients admitted for rehabilitation, reporting dietary intake, anthropometric, biochemical or functional outcomes. The reviewers determined study eligibility and assessed the included studies for risk of bias. Outcome data were combined narratively and by meta-analyses. From 1765 publications, 10 studies trialling oral nutrition supplements, foodservice interventions and clinical care processes (of neutral or positive quality) were identified. Compared to meals alone, oral nutritional supplements significantly improved energy and protein intake, with some evidence for improvements in anthropometry and length of stay. There was little evidence that speciality supplements were beneficial compared to standard versions. Meta-analyses demonstrated significantly greater energy [weighted mean difference (WMD) = 324 kcal, 212-436 kcal 95% confidence interval (CI)] and protein (WMD = 9.1 g, 0.2-17.9 g 95% CI) intake with energy dense meals. Opposing results were reported in studies investigating enhanced clinical care processes. The provision of oral nutrition supplements and energy dense meals improved energy and protein intake and therefore may comprise effective strategies for addressing malnutrition in rehabilitation. The effect of these strategies on other nutritional and functional outcomes should be explored further.
Publisher: MDPI AG
Date: 16-11-2019
DOI: 10.3390/NU11112798
Abstract: A client-centred approach sits at the core of modern healthcare. Exploration of the patients’ role within the education of nutrition and dietetic students has not previously been undertaken. This review aimed to synthesise the learning outcomes that result from involvement of patients in nutrition and dietetic student education, and to consider whether these interactions promote patient-centred care. Five electronic databases were searched, supported by hand-searching of references of included studies. Screening of title/abstract and then full text papers was undertaken key characteristics and outcomes were extracted and synthesised narratively. The likely impact of interventions was evaluated using Kirkpatrick’s Hierarchy study quality was assessed using the Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist. Of 7436 studies identified through database searching, and one additional study located through hand searching of reference lists, the final library consisted of 13 studies. All studies reported benefits for student learning from patient involvement, while one paper identified patient benefits from student interventions. Patients as recipients of care mostly contributed in a passive role in student education activities. Quality assessment identified methodological limitations in most studies. Patient involvement in the education of dietitians supports skill development and therefore progression to professional practice. Although nutrition and dietetics education has a focus on client-centred care, the translation of these concepts into an interactive student educational experience has been investigated to a limited extent. Collaboration with patients in student education is an area for further development.
Publisher: Wiley
Date: 19-10-2019
Abstract: Foodservice is a key component of dietetics education and practice internationally yet benchmarks for competency are limited. This study sought to review and moderate an assessment artefact of foodservice work integrated learning (WIL) to develop a shared understanding of one tool which may be used in a suite of evidence to demonstrate competence. The foodservice curricula and assessment artefacts were described for the foodservice program at each of four participating universities. An assessment artefact from WIL, the report, was identified as an indicator of foodservice competence common to each program. Each university provided four purposively s led WIL reports, assessed in duplicate by two academics from other participating universities using the corresponding university assessment rubric. Collated assessment results, along with the original assessment, were presented back to assessors. A semi-structured group discussion explored variations in assessment results, factors influencing decisions, and potential changes needed for assessment documentation. There was variation in assessment outcomes between independent assessors. In some instances assessors did not consistently deliver the same assessment outcome, nor rank students in sequential order of performance. This variation was less where an absolute ranking of satisfactory/unsatisfactory was applied. The assessor discussion revealed three key concepts: importance of understanding the project scope challenges which influence assessment decision making importance of understanding the broader program of assessment. Assessment inconsistencies emphasise the importance of multiple assessors and assessment artefacts across a programmatic assessment model, and the need for a clear understanding of competence in nutrition and dietetics.
Publisher: Wiley
Date: 29-07-2021
DOI: 10.1111/JHN.12793
Abstract: The image of dietitians presented on the Internet shapes public perception of the profession, which in turn may influence engagement with professionals. The aim was to describe the portrayal of the dietetic profession on the Internet and how this aligns with international professional demographics. In this cross-sectional observational study, images appearing in two Google image searches using the word 'dietitian' were analysed for content by two independent researchers. A coding framework was used to identify personal characteristics of professionals and others presented in the image, as well as the work setting. These were compared to demographic data of members of professional associations in Australia, the United Kingdom (UK) and the United States of America (USA). The dietitian portrayed in the images (n = 339) was most often female (88%), Caucasian (72%), aged between 26-39 years (63%), pictured alone (78%), pictured with food (78%) and in a setting that could not be determined (76%). The age and gender profile presented matches the characteristics of the international workforce however, there was an absence of images illustrating dietitians in authentic work roles. The images resulting from an online search for 'dietitian' do not fully illustrate the profession. There are opportunities to create and share authentic images online that show the breadth of work roles and ersity of professionals' age, gender, cultural background and size.
Publisher: Wiley
Date: 12-06-2019
Abstract: As a s le of research outputs supported by the nutrition and dietetics profession in Australia, the present study aimed to conduct a content analysis of Dietitians Association of Australia (DAA) conference abstracts to identify themes, methods and contribution by geographical location over time. Conference abstracts published during the period 2008-2018 (excluding those from the International Congress of Dietetics in 2012) were obtained. Key outcome data including topics of research and methodological approach were extracted. Leximancer, a computer-assisted content analysis program, was used in the development of concept maps. Thematic analysis was undertaken independently by two authors and consensus was obtained. A total of 2246 oral and poster presentation abstracts and 56 plenary abstracts were imported and synthesised. The most commonly utilised research designs were cross-sectional studies and evaluation research. There was a significant increase in the proportion of systematic literature reviews, and a decreasing proportion of randomised controlled trials presented across the study period. Output was greatest from authors in Queensland and New South Wales. A clear spike in abstracts was observed for the host state across all years. Since 2015 concept maps appeared more interconnected, suggesting a trend for research focus towards integrated nutrition topics. Overarching themes for emerging research topics included Indigenous nutrition and the curriculum for dietetics education. Food/foods emerged as a theme across multiple research methods and in a wide range of contexts and settings. The synthesis of findings suggests that research presented at the DAA conference is largely practice driven.
Publisher: Wiley
Date: 06-2000
Publisher: Wiley
Date: 13-12-2019
DOI: 10.1111/MEDU.13782
Abstract: The skills and qualities of effective clinical educators are linked to improved student learning and ultimately patient care however, within allied health these have not yet been systematically summarised in the literature. To identify and synthesise the skills and qualities of clinical educators in allied health and their effect on student learning and patient care. A systematic search of the literature was conducted across five electronic databases in November 2017. Study identification, data extraction and quality appraisal were performed in duplicate. Qualitative and quantitative data were extracted separately but analysed together using a thematic analysis approach whereby items used in quantitative surveys and themes from qualitative approaches were interpreted together. Data revealed seven educator skills and qualities: (i) intrinsic and personal attributes of clinical educators (ii) provision of skillful feedback (iii) teaching skills (iv) fostering collaborative learning (v) understanding expectations (vi) organisation and planning and (vii) clinical educators in their professional role. Across all themes was the concept of taking time to perform the clinical educator role. No studies used objective measurements as to how these skills and qualities affect learning or patient care. Despite much primary evidence of clinical educator skills and qualities, this review presents the first synthesis of this evidence in allied health. There is a need to examine clinical education from new perspectives to develop deeper understanding of how clinical educator qualities and skills influence student learning and patient care.
Publisher: Elsevier BV
Date: 2020
No related grants have been discovered for Judi Porter.