ORCID Profile
0000-0002-4498-4342
Current Organisations
Royal Brisbane and Women's Hospital
,
University of Queensland
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Publisher: MDPI AG
Date: 28-02-2022
DOI: 10.3390/NU14051037
Abstract: Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily in idually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three in idual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors balancing value and risk of delegation creating competence, capability, and capacity and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as in iduals and in their collective healthcare roles, moving from words to actions that value delegation engaging in processes to improve competency, capability, and capacity of all and being responsive to climate and contextual factors.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJOPEN-2021-058725
Abstract: To develop a minimum dataset to be routinely collected across a heterogenous population within a subacute rehabilitation service to guide best care and outcomes for patients, and value for the health service. Three-round e-Delphi exercise, followed by consensus meetings. Multicentre study in Brisbane, Australia. Rehabilitation decision-makers, researchers and clinicians were invited to participate in the e-Delphi exercise. A multidisciplinary project steering committee (rehabilitation decision makers, researchers, clinicians and consumers) participated in consensus meetings. In round 1 of the e-Delphi, participants responded to an open-ended question, generating data and outcomes that should be routinely collected in rehabilitation. In rounds 2 and 3, participants rated the importance of collecting each item on a nine-point scale. Consensus was defined a priori, as items rated as ‘essential’ by at least 70%, and of ‘limited importance’ by less than 15%, of respondents. Consensus meetings were held to further refine and define the dataset for implementation. In total, 38 participants completed round 1 of the e-Delphi. Qualitative content analysis of their responses generated 1072 codes, which were condensed into 39 categories and 209 subcategories. Following two rounds of rating (round 2: n=32 participants round 3: n=28 participants), consensus was reached for 124 items. Four consensus meetings (n=14 participants) resulted in the final dataset which included 42 items across six domains: (1) patient demographics, (2) premorbid health and psychosocial information, (3) admission information, (4) service delivery and interventions, (5) outcomes and (6) caregiver information and outcomes. We identified 42 items that reflect the values and experiences of rehabilitation stakeholders. Items unique to this dataset include caregiver information and outcomes, and detailed service delivery and intervention data. Future research will establish the feasibility of collection in practice.
Publisher: Wiley
Date: 02-02-2018
Abstract: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n = 39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4 ± 2.9 kg vs -1.0 ± 3.7 kg, P = 0.060). Greater improvement in gait speed was seen in HHOME group (+0.24 ± 0.27 vs +0.11 ± 0.22, P = 0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10% died within 12 weeks post-discharge. The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.
Publisher: Wiley
Date: 18-10-2023
Publisher: Wiley
Date: 13-02-2018
Abstract: Changing population demographics, service demands, and healthcare provider expectations suggest that a shift is required regarding how malnutrition care is managed in hospitals. The present study aims to build the reason for required change, and to describe the process used to develop a model for managing malnutrition for implementation across six Queensland hospitals. A cross-sectional survey of approaches to managing malnutrition in Queensland public hospitals, and development of a new model of care (guided by Knowledge-to-Action Framework and qualitative interviews) for testing within a broader implementation program. Twenty-three surveys were distributed with 21 completed by metropolitan (n = 11), regional (n = 8), and rural/remote (n = 2) settings. Substantial within and across site variance was observed, with care processes focused towards highly in idualised, dietitian delivered care. Some early adopter sites demonstrated systematic, interdisciplinary or delegated malnutrition care processes however, the latter was rarely or never undertaken in eight sites. A model for the Systematised, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation (SIMPLE) in hospitals was drafted based on identified contemporary models and supporting literature. A mixed-methods approach combined survey data with structured interviews conducted in six sites, purposively s led for maximal variation to iteratively refine the model. Consensus for implementation of the final model was achieved across site clinicians, leaders, and governance structures. Systematised, delegated, and interdisciplinary nutrition care activities are realistic in at least some settings. A model is now available to provide interdisciplinary care. Next steps including testing implementation will determine if this interdisciplinary model improves malnutrition care delivered in hospitals.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JAND.2017.03.019
Abstract: The validity of the Malnutrition Screening Tool (MST) in geriatric rehabilitation has been evaluated in a research environment but not in professional practice. In older adults admitted to rehabilitation, this study was undertaken to compare the MST scoring agreement (inter-rater reliability) between health professionals with and without malnutrition risk and screening training to evaluate the concurrent validity of the MST completed by the trained and untrained health professionals compared to the International Classification of Diseases, Tenth Revision, Australian Modification using different MST score cutoffs and to determine whether patient characteristics were associated with MST scoring accuracy when completed by health professionals without malnutrition risk and screening training. This was an observational, cross-sectional study. Fifty-seven older adults (mean age=79.1±7.3 years) were recruited from August 2013 to February 2014 from two rural rehabilitation units in New South Wales, Australia. MST, International Classification of Diseases, Tenth Revision, Australian Modification, classification of malnutrition, and patient characteristics were used to measure outcomes. Measures of diagnostic accuracy generated from a contingency table, receiver operating characteristic curve, and Spearman's correlation were used. The MST scores completed by health professionals with and without malnutrition risk and screening training showed moderate correlation and fair agreement (r The application of the MST by health professionals without malnutrition risk and screening training in rehabilitation may not provide sufficient accuracy in identifying patients with malnutrition risk. Using an MST score of ≥2 to indicate malnutrition risk is recommended, as increasing the MST cutoff score to ≥3 is likely to have insufficient accuracy, even when completed by health professionals with malnutrition risk and screening training. Research evaluating the impact of providing rehabilitation staff with regular and ongoing training in completing malnutrition screening and referral pathways is warranted.
Publisher: Wiley
Date: 08-01-2021
Abstract: This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged‐care facility settings. Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non‐communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large‐scale, well‐designed experimental studies to assess the potential impacts of these interventions.
Publisher: Dietitians of Canada
Date: 12-09-2020
Abstract: This study aimed to determine dietitians' familiarity with knowledge translation (KT), confidence in undertaking KT, and preferences for receiving KT training. An online questionnaire was designed and disseminated to all dietitians working across hospital and health services in Queensland, Australia, for completion over a 6-week period (April-May 2018). Of the 124 respondents, 69% (n = 85) reported being familiar with KT, but only 28% (n = 35) reported being confident in applying KT to their practice. Higher confidence was reported with problem identification, evidence appraisal, and adapting evidence to local context, compared with implementation, evaluation, and dissemination. Almost all respondents reported an interest in learning more about KT (n = 121, 98%), with a preference for easily accessible and short "snippets" of training aimed at beginner-intermediate level. Lack of management support, difficulty attending multi-day courses, cost, travel requirements, and lack of quarantined time were reported barriers to attending KT training. There is a high awareness and interest but low confidence in undertaking KT amongst dietitians. This highlights an opportunity for workforce development to prepare dietitians to be skilled and confident in KT. Training and support needs to be low-cost and multi-modal to meet erse needs.
Publisher: Wiley
Date: 27-07-2017
Abstract: Malnutrition has a significant impact on patient outcomes and duration of inpatient stay. However, conducting timely nutrition assessments can be challenging for rural dietitians. A solution could be for allied health assistants (AHAs) to assist with these assessments. The present study aimed to assess the accuracy and confidence of AHAs trained to conduct the subjective global assessment (SGA) compared with dietitians. A non-inferiority study design was adopted. Forty-five adult inpatients admitted to a rural and remote health service were assessed independently by both a trained AHA and dietitian within 24 hours. The order of assessment was randomised, with the second assessor blind to the outcome of the initial SGA. Levels of agreement were examined using kappa and percent exact agreement (PEA set a priori at ≥80%). Rater confidence after each assessment was assessed using a 10-point scale. Agreement for overall SGA ratings was high (kappa = 0.84 PEA 84.4%). PEA for in idual sub-components of the SGA ranged from 66.4 to 86.7%. Where discrepancies were identified in global SGA ratings, AHAs provided a more severe rating of malnutrition than dietitians. AHAs reported significantly lower confidence than dietitians (t = 4.49, P < 0.001), although mean confidence for both groups was quite high (AHA=7.5, dietitians = 9.0). Trained AHAs completed the SGA with similar accuracy to dietitians. Using AHAs may help facilitate timely nutrition assessment in rural health services when a dietitian is not physically present. Further investigation is required to determine the benefits of incorporating this extended role into rural and remote health-care services.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.CLNU.2010.12.007
Abstract: Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.
Publisher: Wiley
Date: 09-09-2021
DOI: 10.1111/JHN.12940
Abstract: Patient centred care (PCC) positively influences in idual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC because effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through in idual consultations with adult patients undertaking subacute rehabilitation. Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, ‘in idualised care’, ‘tailored advice’, ‘follow‐up’ and ‘team collaboration’. This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that the delivery of care which is truly patient centred is far more comprehensive than in idualising interventions or organising ongoing services. This raises the question: is the delivery of nutrition care in subacute rehabilitation unit's patient centred?
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.NUT.2012.04.007
Abstract: Although several validated nutritional screening tools have been developed to "triage" inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods. This was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization. In this s le of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more "at-risk" patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital. Because all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.
Publisher: Springer Science and Business Media LLC
Date: 16-09-2022
DOI: 10.1007/S00520-022-07348-0
Abstract: To understand and compare the nutrition care experiences of carers supporting patients throughout surgery and radiation treatment for head and neck cancer (HNC) to inform changes to service delivery in the inpatient and outpatient setting to ensure carers needs in their supportive role throughout the treatment and survivorship period are met. As part of a larger study, narrative interviews were completed with fourteen carers of patients diagnosed with HNC at 2 weeks, 3 months and 12 months post-treatment completion. Reflexive thematic analysis was used to interpret and understand differences in carer experiences of nutrition care between surgery and radiation treatment. Two main themes across each treatment modality were identified: (1) access to information and support from healthcare professionals and (2) adjustment to the physical and psychological impact of treatment. This study highlights the increasing need to ensure carers are included in the provision of nutrition information and support to patients throughout and beyond their treatment trajectory. Having structured support available to patients and carers throughout radiation treatment meant that carer needs were reduced. However, without the opportunity for structured support in the inpatient setting, many carers expressed high care needs in supporting patients in the post-surgical phase. Providing carers with access to structured support for nutrition care in the inpatient and outpatient setting can reduce their supportive care needs throughout the treatment and survivorship period.
Publisher: Wiley
Date: 07-06-2023
Abstract: Standardised enteral nutrition protocols are recommended in critical care, however their use and safety are not well described in other inpatient populations. This mixed methods study reports on the use and safety of enteral nutrition protocols for non‐critically ill adults. A scoping review of published literature was conducted. In addition a retrospective audit of practice at an Australian tertiary teaching hospital with an existing hospital‐wide standardised enteral nutrition protocol was performed. Data on use, safety and adequacy of enteral nutrition prescription were collected from medical records for patients receiving enteral nutrition on acute wards (January–March 2020). Screening of 9298 records yielded six primary research articles. Studies were generally low quality. Published literature suggested that protocols may reduce time to enteral nutrition initiation and goal rate, and improve adequacy of nutrition provision. No adverse outcomes were reported. From the local audit of practice (105 admissions, 98 patients), enteral nutrition commencement was timely (median 0 (IQR 0–1) days from request goal rate: median 1 (IQR 0–2) days from commencement and adequate (nil underfeeding), without prior dietitian review in 82% of cases. Enteral nutrition was commenced per protocol in 61% of instances. No adverse events, including refeeding syndrome, were observed. Most inpatients requiring enteral nutrition can be safely and adequately managed on enteral nutrition protocols. Evaluation of protocols outside of the critical care setting remains a gap in the literature. Standardised enteral nutrition protocols may improve delivery of nutrition to patients, whilst allowing dietitians to focus on those with specialised nutrition support needs.
Publisher: Informa UK Limited
Date: 30-09-2023
Publisher: MDPI AG
Date: 10-04-2021
DOI: 10.3390/HEALTHCARE9040446
Abstract: Approximately one-third of adult inpatients are malnourished with substantial associated healthcare burden. Delegation frameworks facilitate improved nutrition care delivery and high-value healthcare. This study aimed to explore knowledge, attitudes, and practices of dietitians and dietitian assistants regarding delegation of malnutrition care activities. This multi-site study was nested within a nutrition care implementation program, conducted across Queensland (Australia) hospitals. A quantitative questionnaire was conducted across eight sites 87 dietitians and 37 dietitian assistants responded and descriptive analyses completed. Dietitians felt guidelines to support delegation were inadequate (agreement: % for assessment/diagnosis, care coordination, education, and monitoring and evaluation) dietitian assistants perceived knowledge and guidelines to undertake delegated tasks were adequate (agreement: % food and nutrient delivery, education, and monitoring and evaluation). Dietitians and dietitian assistants reported confidence to delegate/receive delegation (dietitian agreement: % across all care components dietitian assistant agreement: % for assessment/diagnosis, food and nutrient delivery, education, monitoring and evaluation). Practice of select nutrition care activities were routinely performed by dietitians, rather than assistants (p 0.001 across all nutrition care components). The process for care delegation needs to be improved. Clarity around barriers and enablers to delegation of care prior to implementing reforms to the current models of care is key.
Publisher: Wiley
Date: 11-05-2023
Abstract: Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. Literature review, multidisciplinary focus groups and end‐user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject in idual items. Scale reliability was assessed using Cronbach's alpha. The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub‐scales related to (1) Personal Staff Role (2) Food Service (3) Organisational Support, and (4) Family Involvement each sub‐scale demonstrated good reliability with Cronbach's alpha values all .70. This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small s le. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2020
DOI: 10.1186/S12913-020-05354-8
Abstract: The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Its underlying philosophy is that implementing research into healthcare practice is complex, unpredictable and non-linear which therefore requires a flexible and responsive approach to implementation. Facilitation is recognized as the central ingredient of this approach, and i-PARIHS now provides a Facilitation Guide with associated tools. This multiple case study of four implementation projects explored how the i-PARIHS framework has been practically operationalized by erse implementation project teams. A co-design approach was used to elicit the experiences of four implementation project teams who used the i-PARIHS framework to guide their implementation approach. We conducted the established co-design steps of (i) setting up for success, (ii) gathering the experience, and (iii) understanding the experience. In particular we explored teams’ approaches to setting up their projects why and how they used the i-PARIHS framework and what they learnt from the experience. We found both commonalities and differences in the use of i-PARIHS across the four implementation projects: (i) all the projects used the Facilitation Checklist that accompanies i-PARIHS as a starting point, (ii) the projects differed in how facilitation was carried out, (iii) existing tools were adapted for distinct phases: pre-implementation, during implementation, and post-implementation stages and (iv) project-specific tools were often developed for monitoring implementation activities and fidelity. We have provided a detailed overview of how current users of i-PARIHS are operationalising the framework, which existing tools they are using or adapting to use, and where they have needed to develop new tools to best utilise the framework. Importantly, this study highlights the value of existing tools from the published i-PARIHS Facilitation Guide and provides a starting point to further refine and add to these tools within a future Mobilising Implementation of i-PARIHS (or “Mi-PARIHS”) suite of resources. Specifically, Mi-PARIHS might include more explicit guidance and/or tools for developing a structured implementation plan and monitoring fidelity to the implementation plan, including recording how strategies are tailored to an evolving context.
Publisher: Wiley
Date: 05-12-2023
DOI: 10.1111/ANS.18007
Publisher: Wiley
Date: 09-2015
Publisher: American Astronomical Society
Date: 10-2022
Abstract: We report the serendipitous discovery of an elliptical shell of CO associated with the faint stellar object SSTc2d J163134.1-240060 as part of the “Ophiuchus Disk Survey Employing ALMA” (ODISEA), a project aiming to study the entire population of protoplanetary disks in the Ophiuchus Molecular Cloud from 230 GHz continuum emission and 12 CO ( J = 2–1), 13 CO ( J = 2–1) and C 18 CO ( J = 2–1) lines readable in Band 6. Remarkably, we detect a bright 12 CO elliptical shape emission of ∼3″ × 4″ toward SSTc2d J163134.1-240060 without a 230 GHz continuum detection. Based on the observed near-IR spectrum taken with the Very Large Telescope (KMOS), the brightness of the source, its three-dimensional motion, and Galactic dynamic arguments, we conclude that the source is not a giant star in the distant background ( –10 kpc) and is most likely to be a young brown dwarf in the Ophiuchus cloud, at a distance of just ∼139 pc. This is the first report of quasi-spherical mass loss in a young brown dwarf. We suggest that the observed shell could be associated with a thermal pulse produced by the fusion of deuterium, which is not yet well understood, but for a substellar object is expected to occur during a short period of time at an age of a few Myr, in agreement with the ages of the objects in the region. Other more exotic scenarios, such as a merger with planetary companions, cannot be ruled out from the current observations.
Publisher: Wiley
Date: 04-2019
Abstract: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2018
DOI: 10.1038/S41430-018-0276-X
Abstract: Aligning care with best practice-such as Enhanced Recovery After Surgery (ERAS) guidelines-may improve patient outcomes. However, translating research into practice is challenging and implementation science literature emphasises the importance of understanding barriers and enablers specific to the local context and clinicians. This study aimed to explore staff perceptions about barriers and enablers to practice change aligning with nutrition-related recommendations from ERAS guidelines. A qualitative study using a maximum variation s ling method. Clinicians involved in care of patients admitted to two general surgical wards consented to participate in semi-structured interviews. Framework analysis was undertaken using the integrated Promoting Action on Research Implementation in Health Services framework to identify a priori and emergent themes. From interviews with 13 clinicians (two surgical consultants, one registrar, one intern one anaesthetist two nurse unit managers, one surgical nurse coordinator, three nurses two dietitians), three major themes were identified: (a) complexity of the context (e.g., unpredictable theatre times, requirement for flexibility and large, multidisciplinary workforce) (b) strong decision-making hierarchy, combined with lack of knowledge, confidence or authority of junior and non-surgical staff to implement change and (c) poor communication and teamwork (within and between disciplines). These barriers culminate in practice where default behaviours are habit, and the view that achieving clinical consensus is challenging. This study highlights the necessity for a multifaceted implementation approach that simplifies the process, flattens the power differential and facilitates communication and teamwork. Other facilities may consider these findings when implementing similar practice change interventions.
Publisher: Informa UK Limited
Date: 02-07-2018
DOI: 10.1080/21551197.2018.1483281
Abstract: This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n = 30 mean age 79 years, 47% male). Data were collected on intake of each meal component (none, ¼, ½, ¾, all converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor seven-point scale) and meal quality (sensory properties, temperature five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524 ± 927 kJ vs. 2692 ± 857 kJ, p = 0.612 protein: 29 ± 12 g vs. 27 ± 11 g, p = 0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.
Publisher: MDPI AG
Date: 04-11-2020
DOI: 10.3390/HEALTHCARE8040459
Abstract: Obesity is costly, yet there have been few attempts to estimate the actual costs of providing hospital care to the obese inpatient. This study aimed to test the feasibility of measuring obesity-related health care costs and accuracy of coding data for acute inpatients. A prospective observational study was conducted over three weeks in June 2018 in a single orthopaedic ward of a metropolitan tertiary hospital in Queensland, Australia. Demographic data, anthropometric measurements, clinical characteristics, cost of hospital encounter and coding data were collected. Complete demographic, anthropometric and clinical data were collected for all 18 participants. Hospital costing reports and coding data were not available within the study timeframe. Participant recruitment and data collection were resource-intensive, with mobility assistance required to obtain anthropometric measurements in more than half of the participants. Greater staff time and costs were seen in participants with obesity compared to those without obesity (obesity: body mass index ≥ 30), though large standard deviations indicate wide variance. Data collected suggest that obesity-related cost and resource use amongst acute inpatients require further exploration. This study provides recommendations for protocol refinement to improve the accuracy of data collected for future studies measuring the actual cost of providing hospital care to obese inpatients.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
Publisher: Wiley
Date: 27-06-2018
DOI: 10.1111/JHN.12572
Abstract: Malnutrition is prevalent across acute care facilities, particularly in older patients, and contributes to poor surgical outcomes. Clinical practice guidelines recommend the early reintroduction of a full oral diet post-operatively. The present study aimed to compare estimated energy (EEI) and protein (EPI) intake of patients who received early diet upgrade with those who did not. Patients ≥65 years admitted post-operatively to general surgical wards were included. EEI and EPI were calculated and dichotomised as meeting ≥50% or <50% estimated energy (EER) and protein (EPR) requirements. Mean intake and proportion of patients meeting <50% estimated requirements were compared between those who received early upgrade and those who did not at post-operative day (POD)2. Thirty-four patients [mean (SD) age 72.9 (5.7) years, 59% male] were analysed at POD2 [EEI: mean 4.2 (2.6) MJ day Although the majority of older patients received early diet upgrade and these patients consumed more energy and protein than those on fluid diets, as a whole, older patients ate poorly post-operatively. Fluid diets should therefore not be used indiscriminately and other approaches to improve post-operative intake of older patients, such as fortified diets, oral nutritional supplements and meal environment interventions, should be adopted.
Publisher: Wiley
Date: 04-2017
Abstract: To develop and test the reliability of a Meal Quality Audit Tool (MQAT) to audit the quality of hospital meals to assist food service managers and dietitians in identifying areas for improvement. The MQAT was developed using expert opinion and was modified over time with extensive use and feedback. A phased approach was used to assess content validity and test reliability: (i) trial with 60 dietetic students, (ii) trial with 12 food service dietitians in practice and (iii) interrater reliability study. Phases 1 and 2 confirmed content validity and informed minor revision of scoring, language and formatting of the MQAT. To assess reliability of the final MQAT, eight separate meal quality audits of five identical meals were conducted over several weeks in the hospital setting. Each audit comprised an 'expert' team and four 'test' teams (dietitians, food services and ward staff). Interrater reliability was determined using intra-class correlation analysis. There was statistically significant interrater reliability for dimensions of Temperature and Accuracy (P < 0.001) but not for Appearance or Sensory. Composition of the 'test' team appeared to influence results for Appearance and Sensory, with food service-led teams scoring higher on these dimensions. 'Test' teams reported that MQAT was clear and easy to use. MQAT was found to be reliable for Temperature and Accuracy domains, with further work required to improve the reliability of the Appearance and Sensory dimensions. The systematic use of the tool, used in conjunction with patient satisfaction, could provide pertinent and useful information regarding the quality of food services and areas for improvement.
Publisher: Wiley
Date: 28-08-2018
Abstract: To describe prospective application of an implementation framework to guide and evaluate a quality improvement (QI) project to improve adherence to evidence-based postoperative diet guidelines (consistent with Enhanced Recovery After Surgery, ERAS) in older surgical patients. A hybrid mixed methods study guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used. A pre-implementation audit identified gaps in nutrition-related care practices against ERAS guidelines for older surgical patients. Qualitative interviews explored barriers to practice change, informing development of the facilitated implementation strategy. Iterative facilitation interventions were identified by field notes and classified using i-PARIHS facilitator's tool-kit. Post-implementation audit measured implementation outcomes, and clinical processes and outcomes using controlled before-after comparative study. Implementation involved 17 discrete facilitation activities. Early postoperative diet upgrade was acceptable, well adopted (79%) and appropriate for 89% of patients. Fidelity (i.e. protocol delivered as intended) was 59%, with loss of fidelity primarily because of incorrect diet codes. Clinical processes and outcome evaluation (n = 155) compared data pre-implementation (intervention: n = 45, control: n = 27 mean age 73 (SD 6) years, 60% male) and post-implementation (intervention: n = 47, control: n = 36 mean age 74 (SD 6) years, 57% male). Patients on the intervention ward had higher odds of receiving early nutrition post-implementation (adjusted odds ratio [95% CI]: 6.5 [1.9-22.4], P = 0.01). Prospective application of an implementation framework supported planning and successful implementation in this QI project. Multi-level evaluation of facilitation strategies, implementation outcomes, and clinical processes and outcomes helps to understand areas of success and continuing challenges.
Publisher: Wiley
Date: 25-01-2021
DOI: 10.1111/JHN.12854
Abstract: Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients however, patient‐reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient‐reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. A cross‐sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27‐item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care ( P = 0.01). This survey highlights areas of positive patient‐reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.
Publisher: CSIRO Publishing
Date: 08-12-2020
DOI: 10.1071/AH20192
Abstract: Australia’s clinical research communities responded quickly to COVID-19. Similarly, research funding to address the pandemic was appropriately fast-tracked and knowledge promptly disseminated. This swift and purposeful research response is encouraging and reflects thorough and meticulous training of the academic workforce in particular the clinician scientist. Clinician scientists have formal clinical and research qualifications (primarily PhD), and are at the forefront of translating knowledge into health care. Yet in reality, advances in medical research are not rapid. Scientific discovery results from the long-term accumulation of knowledge. The drivers of this knowledge are often PhD students who provide new lines of clinical inquiry coupled with the advanced training of early- and mid-career researchers who sustain discovery through a clinician scientist workforce. A crucial point during these COVID-19 times is that this initial investment in training must be nurtured and maintained. Without this investment, the loss of a future generation of potential discoveries and a vibrant scientific workforce to safeguard us from future global health threats is at risk. This risk includes the modest gains achieved by increasing female and minority representation in STEM and the clinician scientist workforce. COVID-19 has presented serious concerns to Australia’s health and economy. This perspective is central to these concerns and urges investment in the continuity of training and maintaining a sustainable clinician scientist workforce sufficient to address current and future pandemics, alongside continuing discoveries to improve the health of Australians.
Publisher: Informa UK Limited
Date: 16-08-2023
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.CLNESP.2019.03.018
Abstract: Food avoidance is common with Inflammatory Bowel Disease (IBD) and adherence to dietary guidelines is poor, contributing to under and over nutrition. Reasons for food avoidance have not been previously explored in detail. This study of IBD outpatients aimed to describe food avoidance patterns and rationale behind this, and describe source and confidence with dietary advice. A prospective cross-sectional study using structured interview, nutritional assessment and medical record review was conducted in patients with confirmed diagnosis of IBD (n = 117) attending outpatient clinics over a six-month period. Participants were interviewed on foods avoided, rationale for food avoidance and previous dietary advice (source and confidence). Means ± SD or medians (IQR), percentages and counts were used to describe participant characteristics, food avoidance, and source and confidence in dietary advice. Bivariate analysis was used to explore relationships between food avoidance and disease factors (IBD subtype disease activity: active disease vs remission), and between confidence in dietary advice and disease activity. Almost all participants reported food avoidance (90%), with more foods avoided during active disease (5.2 ± 3.6 foods/food categories, versus remission 2.9 ± 2.5, p < 0.001). Lactose-containing foods were avoided by 40% of patients in active disease and 33% in remission. Pain/cr ing, increased bowel motions and diarrhea were the most common reasons for avoiding foods/food categories during both active disease and remission. Participants were most confident in advice received from the internet (3.3 ± 1.2 dietitian: 2.8 ± 1.5) in active disease in remission participants had greatest confidence in advice received from gastroenterologists (4.1 ± 0.8 dietitian: 3.5 ± 1.2). High prevalence of avoidance of nutritious foods and low confidence in dietetic advice amongst people with IBD is of concern. Further work is needed to build trust and ensure patients are provided with evidence-based nutrition recommendations to manage their symptoms whilst optimizing nutritional quality of their diet.
Publisher: Wiley
Date: 05-04-2021
Abstract: Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. A multi‐site (five hospitals) prospective, pre‐post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at‐risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient‐reported nutrition experience measures. Pre‐implementation (n = 365) and post‐implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at‐risk). Post‐implementation, at‐risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9% P .01), nutrition information (30.9% vs 47.2% P .01), mealtime assistance where required (61.4% vs 77.9% P = .04), nutrition monitoring (25.2% vs 46.3% P .01) and care planning (17.8% vs 27.7% P = .01). Patient‐reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25 P = .83). Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at‐risk inpatients within existing dietetic resources.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2021
Publisher: Springer Science and Business Media LLC
Date: 27-02-2021
DOI: 10.1186/S12877-021-02098-W
Abstract: With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system. In this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines. Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care skilled compassionate staff work in effective teams and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce. Progress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.MATURITAS.2017.01.004
Abstract: Protein-energy malnutrition is common amongst people aged 65 years and older, has a multifactorial aetiology, and numerous negative outcomes. Domiciliary carers (non-clinical paid carers) and family carers (including family, friends and neighbours) are required to support the increasing demand for in-home assistance with activities of daily living due to the ageing population. This review provides insight into the role of both domiciliary and family carers in providing in idualised nutrition support for older, community-dwelling adults with malnutrition. Four electronic databases were searched for intervention studies from database inception to December 2016. Both domiciliary and family carers are well placed to monitor the dietary intake and nutritional status of older adults to assist with many food-related tasks such as the sourcing and preparation of meals, and assisting with feeding when necessary and to act as a conduit between the care recipient and formal nutrition professionals such as dietitians. There is moderate evidence to support the role of domiciliary carers in implementing nutrition screening and referral pathways, and emerging evidence suggests they may have a role in malnutrition interventions when supported by health professionals. Moderate evidence also supports the engagement of family carers as part of the nutrition care team for older adults with malnutrition. Interventions such as group education, skill-development workshops and telehealth demonstrate promise and have significantly improved outcomes in older adults with dementia. Further interventional and translational research is required to demonstrate the efficacy of engaging with domiciliary and family carers of older adults in the general community.
Publisher: Wiley
Date: 16-04-2018
Abstract: Hand grip strength (HGS) has been proposed as an indicator of nutritional status that is objective, requires minimal assessor training and is quick to administer, making it attractive for use in the acute setting. This study aimed to determine the discriminatory ability of impaired HGS to screen for malnutrition in an older hospital population and assess the added value of combining this with existing screening tools. Measures were undertaken during acute admission in patients ≥65 years admitted to general surgical wards. Impaired HGS was defined as a mean value below the lower limit of the 95% CI of population norms and observed HGS standardised as a percentage of this value. Nutritional risk was assessed using the Malnutrition Screening Tool (MST) and malnutrition defined as Patient-Generated Subjective Global Assessment (PG-SGA) rating B or C. Discriminatory ability of impaired HGS to identify malnourished patients was tested using the area under the receiver operating characteristic curve (AUC). Seventy-five patients (mean age: 74.0 (SD 6.7) years, 60% male) were recruited. Impaired HGS did not accurately identify malnutrition (AUC (95% CI): 0.41 (0.25-0.58), P < 0.001), nor did it improve discriminatory ability of the MST (AUC (95% CI), MST: 0.83 (0.71-0.95), P = 0.32 MST/HGS combined: 0.68 (0.51-0.86), P = 0.035). HGS was not found to be suitable in screening older inpatients for malnutrition during admission to surgical wards. As such, screening for nutrition risk using an existing validated tool to identify patients for further in-depth nutritional assessment by an appropriately trained clinician remains the preferred method.
Publisher: Emerald
Date: 18-03-2019
DOI: 10.1108/JHOM-03-2018-0071
Abstract: The purpose of this paper is to advance understanding about the facilitation process used in complex implementation projects, by describing the function of novice clinician facilitators, and the barriers and enablers they experience, while implementing a new model of care for managing hospital malnutrition. Semi-structured interviews were undertaken with local facilitators ( n =7) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. Facilitator networks and training supported the clinicians acting as novice facilitators. Key functions of the facilitator role were building relationships and trust understanding the problem and stimulating change through data negotiating and implementing the change and measuring, sharing and reflecting on success. “Dedicated role, time and support” was identified as a theme encompassing the key barriers and enablers to successful facilitation. When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. With these structures in place, facilitators can support iterative improvements through building trust and relationships, co-designing strategies with ch ions and teams and developing internal capacity for change. This case study extends the knowledge about how facilitation works in action, the barriers faced by clinicians new to working in facilitator roles, and highlights the need for an adapt-to-fit approach for the facilitation process, as well as the innovation itself.
Publisher: Wiley
Date: 31-10-2022
DOI: 10.1111/JHN.13099
Abstract: Previous studies have highlighted the unmet nutritional and supportive care needs of patients with head and neck cancer (HNC) and their carers from diagnosis and throughout the treatment and survivorship period. The aim of this study was to bring patients, carers and healthcare professionals together to co‐design a framework to improve access to nutrition information and support for patients and carers with HNC from diagnosis and throughout the treatment and survivorship period. Using experience‐based co‐design (EBCD), semistructured in idual interviews were conducted with patients, carers and healthcare professionals to understand their experiences in accessing information and support outside of the hospital environment. Feedback events and co‐design workshops were held to prioritise areas for service improvement. Participants (10 patients, 7 carers and 15 healthcare professionals) highlighted the importance of having consistent information and support recommendations from the multidisciplinary team. The two key areas for improvement identified through group and workshop events were linking reputable HNC resources to a HNC portal on the hospital website and the development of a series of short podcasts and video blogs with fact sheets attached presented by members of the multidisciplinary team, patients and carers at four time points spanning pretreatment and throughout the survivorship period. Using EBCD has enabled the co‐design of a framework for resource development with patients, carers and healthcare professionals to improve access to information and resources to support nutrition intake and supportive care needs for patients with HNC with their carers. Development and implementation of resources and evaluation of outcomes is ongoing.
Publisher: MDPI AG
Date: 19-04-2023
DOI: 10.3390/HEALTHCARE11081172
Abstract: Background: Inpatient malnutrition is a key determinant of adverse patient and healthcare outcomes. The engagement of patients as active participants in nutrition care processes that support informed consent, care planning and shared decision making is recommended and has expected benefits. This study applied patient-reported measures to identify the proportion of malnourished inpatients seen by dietitians that reported engagement in key nutrition care processes. Methods: A subset analysis of a multisite malnutrition audit limited to patients with diagnosed malnutrition who had at least one dietitian chart entry and were able to respond to patient-reported measurement questions. Results: Data were available for 71 patients across nine Queensland hospitals. Patients were predominantly older adults (median 81 years, IQR 15) and female (n = 46) with mild/moderate (n = 50) versus severe (n = 17) or unspecified severity (n = 4) malnutrition. The median length of stay at the time of audit was 7 days (IQR 13). More than half of the patients included had two or more documented dietitian reviews. Nearly all patients (n = 68) received at least one form of nutrition support. A substantial number of patients reported not receiving a malnutrition diagnosis (n = 37), not being provided information about malnutrition (n = 30), or not having a plan for ongoing nutrition care or follow-up (n = 31). There were no clinically relevant trends between patient-reported measures and the number of dietitian reviews or severity of malnutrition. Conclusions: Malnourished inpatients seen by dietitians across multiple hospitals almost always receive nutritional support. Urgent attention is required to identify why these same patients do not routinely report receiving malnutrition diagnostic advice, receiving information about being at risk of malnutrition, and having a plan for ongoing nutrition care, regardless of how many times they are seen by dietitians.
Publisher: Wiley
Date: 24-10-2021
DOI: 10.1111/JOCN.16096
Abstract: To identify how patients and carers collaborate to manage nutrition care throughout and beyond head and neck cancer (HNC) treatment as a step towards identifying changes to service delivery that are inclusive of the needs of the patient–carer dyad. Research in the field of dyadic interventions in cancer care is emerging, and there has been little work exploring patient–carer dyad needs in the provision of nutrition care in HNC. A qualitative study design was used. Narrative interviews were completed with 13 patients and 15 carers over a 12‐month period (prior to treatment commencing, and 2 weeks, 3 months and 12 months post‐treatment completion). Deductive analysis of interview transcripts was performed using directed content analysis guided by the Theory of Dyadic Illness Management (TDIM). COREQ guidelines were used. Seven themes across four TDIM constructs were identified: (1) understanding and adapting to physical challenges impacting nutrition intake, (2) adjusting to emotional impact of changes to eating and drinking, (3) providing practical support, (4) intrapersonal characteristics, (5) interpersonal characteristics, (6) healthcare culture and (7) managing carer burnout. This study highlights the importance of healthcare professionals recognising the patient and carer dyad as a team to enhance engagement in nutrition care and to ensure that their physical and psychological support needs across the cancer continuum are met. It is important that healthcare professionals understand information and support needs and preferences within patient–carer dyads prior to HNC treatment commencing and adapt care and interventions based on their changing needs throughout and beyond the treatment period.
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.JAND.2017.11.023
Abstract: The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals however, it has not been evaluated for patient-led screening. This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher-led screening and intra-rater reliability between an initial and a repeat patient screening. This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability n=48 intra-rater reliability measured in a separate s le). Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test-retest screening, and patient acceptability. Percent and chance-corrected agreement (Cohen's kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with "almost perfect" chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with "almost perfect" chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%). Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates.
Publisher: Wiley
Date: 16-12-2021
DOI: 10.1111/JAN.14728
Abstract: To investigate the energy and protein adequacy of meals and dietary intake of older psychiatric inpatients and describe patient and mealtime factors potentially influencing intake. Multiple case studies. Psychiatric inpatients aged 65 years and older, admitted to a single mental health ward during the 6‐week study period (April–May 2019) were eligible for inclusion. Dietary intake was observed for two consecutive days each week (minimum four observation days). Visual plate waste methods were used to estimate patients’ dietary intake at mealtimes, with energy and protein intake calculated using known food composition data and compared with estimated requirements. Medical records were reviewed weekly to collect information on potential factors related to intake and mealtime care. Data from all sources were first summarized in a case record for within‐case analysis using descriptive statistics, followed by cross‐case analysis. Eight participants (five men, age 67–90 years, two underweight and one overweight, and four requiring some mealtime assistance) had 5–12 days of observation data recorded. Three met their estimated daily energy and protein requirements throughout the study period, while the remaining five participants did not. The main barriers identified as contributing to insufficient energy and protein intake were as follows: missing meals (asleep and treatment) inadequate food provided (insufficiency of the standard hospital menu) and need for increased mealtime assistance. Poor dietary intake may be common among older psychiatric patients, suggesting that they may also need nursing and multidisciplinary nutrition care interventions shown to effectively prevent and treat malnutrition in other older inpatient groups. Older psychiatric patients experience similar nutrition and mealtime issues to other older inpatients. This study highlights the need for nurses and the multidisciplinary team to ensure patients order and receive adequate food, especially when they miss meals and that they receive proactive mealtime assistance.
Publisher: SERDI
Date: 2015
DOI: 10.14283/JFA.2015.51
Abstract: Background: The post-hospital period may be a vulnerable time for elders recovering from acute illness. Few studies have examined nutrition outcomes of older people at nutrition risk after acute hospitalisation. Objectives: This study aims to describe a) standard nutrition care received by recently discharged older medical patients, b) change in nutritional and functional status at six weeks post-discharge and c) clinical outcomes at twelve weeks post discharge. Design: Prospective cohort study. Setting: Two metropolitan teaching hospitals in Brisbane, Australia. Participants: Medical patients aged ≥65 years at risk of malnutrition (Malnutrition Screening Score ≥2) and discharged to independent living in the community. Measurement: Nutritional status (Mini Nutritional Assessment (MNA), weight, lean body mass), functional status (grip strength, walk speed, activities of daily living) and health-related quality of life assessed on discharge and six weeks post-discharge. Inpatient and post-discharge nutrition intervention was recorded. Death and unplanned admissions were measured at 12 weeks. Results: Of the 42 consented participants, only 14% (n=6) received post-discharge dietitian review and 19% (n=8) received practical nutrition supports at home (meal delivery, shopping assistance) as part of standard care. While there was a small improvement in MNA (18.4±4.0 to 20.1±4.2, p=0.004) and walk speed (0.7±0.3 m/s to 0.9±0.3, p=0.004) at six weeks, there was no difference in mean weight, lean body mass, grip strength or activities of daily living. Five (15%) participants lost ≥5% body weight. By twelve weeks, 17 participants (46%) had at least one unplanned hospital admission and four (10%) had died. Conclusions: Few patients at nutrition risk received nutrition-focussed care in the post-hospital period, and most did not improve nutritional or functional status at 6 weeks.
Publisher: MDPI AG
Date: 11-09-2020
DOI: 10.3390/HEALTHCARE8030334
Abstract: Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patients were recognised as obese by hospital administration. A large variation in the cost of admission across BMI categories prohibited any statistical determination of difference. Obesity is highly prevalent among hospital inpatients in Queensland, Australia. Current methods of identifying obesity for administrative/funding purposes are not accurate and would benefit from reforms to measure the true impact of healthcare costs from obesity.
Publisher: BMJ
Date: 10-06-2017
Publisher: Wiley
Date: 21-03-2016
DOI: 10.1111/JAN.12940
Abstract: To evaluate the impact of mealtime practices (meal time preparation, assistance and interruptions) on meal intake of inpatients in acute hospital wards. It is common for patients to eat poorly while in hospital, related to patient and illness factors and possibly mealtime practices. Few studies have quantified the impact of mealtime practices on the meal intake of hospital patients. Cross-sectional study. Structured observations were conducted at 601 meals across four wards (oncology, medical and orthopaedic and vascular surgical) during 2013. Each ward was observed by two dietitians and/or nurses for two breakfasts, lunches and dinners over 2 weeks. Data were collected on patient positioning, mealtime assistance, interruptions and meal intake (visual estimate of plate waste). Associations between mealtime practices and 'good' intake (prospectively defined as ≥75% of meal) were identified using chi-squared tests. Sitting up for the meal was associated with good intake, compared with lying in bed. Timely mealtime assistance (within 10 minutes) was associated with good intake, compared with delayed or no assistance. Mealtime interruptions had no impact on intake. Forty percent of patients (n = 241) ate half or less of their meal, with 10% (n = 61) eating none of the meal provided. Timely mealtime assistance and positioning for the meal may be important factors that facilitate intake among hospital patients, while mealtime interruptions appeared to have no impact on intake. To improve intake of older inpatients, mealtime programmes should focus on 'assisted mealtimes' rather than only Protected Mealtimes.
Publisher: Springer Science and Business Media LLC
Date: 29-12-2018
DOI: 10.1038/S41430-017-0049-Y
Abstract: Older patients are at increased risk of malnutrition and reduced physical function. Using Enhanced Recovery After Surgery (ERAS) guidelines as an auditing framework, this study aimed to determine adherence of nutrition care to perioperative best practice in older patients. A single researcher retrieved data via chart review. Seventy-five consenting patients ≥65 years (median 72 (range 65-95) years, 61% male) admitted postoperatively to general surgical wards were recruited. Sixty per cent had a primary diagnosis of cancer and 51% underwent colorectal resection. Seventeen per cent and 4% of patients met fasting targets of 2-4 h for fluid and 6-8 h for food, respectively. Fifty-five per cent were upgraded to full diet by first postoperative day. Nil received preoperative carbohydrate loading. Minimally invasive surgery (p = 0.01) and no anastomosis formation (p = 0.05) were associated with receiving ERAS-concordant nutrition care. This study highlights areas for improvement in perioperative nutrition care of older patients at our facility.
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/JHN.13082
Abstract: There is little known about nutrition intervention research involving consumer co‐design. The aim of this scoping review was to identify and synthesise the existing evidence on the current use and extent of consumer co‐design in nutrition interventions. This scoping review is in line with the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute using an adapted 2weekSR approach. We searched Medline, EMBASE, PsycInfo, CINAHL and Cochrane. Only studies that included consumers in the co‐design and met the ‘Collaborate’ or ‘Empower’ levels of the International Association of Public Participation's Public Participation Spectrum were included. Studies were synthesised according to two main concepts: (1) co‐design for (2) nutrition interventions. The initial search yielded 8157 articles, of which 19 studies were included (comprising 29 articles). The studies represented a range of intervention types and participants from seven countries. Sixteen studies were published in the past 5 years. Co‐design was most often used for intervention development, and only two studies reported a partnership with consumers across all stages of research. Overall, consumer involvement was not well documented. No preferred co‐design framework or approach was reported across the various studies. Consumer co‐design for nutrition interventions has become more frequent in recent years, but genuine partnerships with consumers across all stages of nutrition intervention research remain uncommon. There is an opportunity to improve the reporting of consumer involvement in co‐design and enable equal partnerships with consumers in nutrition research.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2021
DOI: 10.1007/S00520-021-06484-3
Abstract: Nutrition care plays a critical role in optimising outcomes for patients receiving treatment for head and neck cancer (HNC), with carers playing an important role in supporting patients to maintain nutrition intake. This study explores patient and carer experience of nutrition care from diagnosis of HNC to 1 year post treatment completion to identify areas for improvement of service delivery. A longitudinal qualitative study design was used with a heterogeneous s le of 20 patients and 15 carers of patients undergoing curative intent treatment for HNC. Interviews conducted at four time points provided a total of 117 interview datasets that were analysed using reflexive thematic analysis based on Gadamerian hermeneutic inquiry. Patient and carer experiences were reflected in two primary themes: (1) the battle to maintain control and (2) navigating the road ahead. This research identifies the need to co-design strategies to improve nutrition care that is inclusive of patients and carers.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.CLNESP.2017.12.009
Abstract: Interventions such as oral nutritional supplements (ONS), fortified meals and mid-meals, feeding assistants and Protected Mealtimes have shown some impact on nutritional intake in research studies, but embedding them in practise remains challenging. This study monitored nutritional intake of older medical inpatients as dietary and mealtime interventions were progressively implemented into routine practise. Series of three prospectively evaluated patient cohorts allowed comparison of nutritional intake of 320 consented medical inpatients aged 65 + years: cohort 1 (2007-8), cohort 2 (2009) and cohort 3 (2013-14) as nutrition care interventions were progressively introduced and embedded. Interventions focused on 'assisted mealtimes', fortified meals and mid-meals, and ONS. Energy and protein intake were calculated from visual plate waste of in idual meal and mid-meal components on day 5 of admission. Nutrition care processes were evaluated by mealtime audits of diet type, assistance and interruptions on the same day. One-way ANOVA and chi square tests were used for comparison between cohorts. Significant, progressive improvements in energy and protein intake were seen between cohorts (energy: cohort 1: 5073 kJ/d cohort 2: 5403 kJ/d cohort 3: 5989 kJ/d, p = 0.04 protein: cohort 1: 48 g/d, cohort 2: 50 g/d, cohort 3: 57 g/d, p = 0.02). Greater use of fortified meals and mid-meals and sustained improvements in mealtime assistance likely contributed to these improvements. Multi-faceted system-level approach to nutrition care, including changes to dietary and mealtime care processes, was associated with measureable and sustained improvements in nutritional intake of older inpatients over a seven year period.
Publisher: Wiley
Date: 28-06-2021
Abstract: Implementation science theories, models and frameworks help to address evidence‐practice gaps, which have increasing importance for dietetic practice. This paper aims to provide dietitians with insight into how implementation science can be applied to practice, using multiple ‘real‐life’ case studies. Three case studies were purposively selected across areas of dietetics practice to demonstrate application of commonly‐used implementation theories, models and frameworks. Reflections from the authors were provided in response to a structured set of questions outlining how the theoretical approach was selected and used, and considerations for future application. Within and cross‐case analysis was undertaken. Dietitians used erse implementation theories, models and frameworks to identify barriers and enablers, to plan for implementation, and to guide the selection of implementation strategies. Implementation theory was used to evaluate the implementation process in one case study. Cross‐case analysis identified that mentoring by those with implementation expertise, multidisciplinary implementation teams, and leadership and investment in research and translation at an organisational and departmental level as key enablers. This paper offers dietitians insight into how implementation science can be applied to improve the uptake of evidence‐based practices within nutrition and dietetics, and suggests that there needs to be investment in implementation science as a foundation science within nutrition and dietetics, including education, training and mentoring for dietitians.
Publisher: Wiley
Date: 22-06-2021
Abstract: There is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients. Ninety trays were s led and assessed independently using the new tool ‘Meal Intake Points’ and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake. This new tool achieved very strong association for energy estimates ( r = .91) and strong association for protein estimates ( r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100% specificity 76%‐80%). Minor revision of the original tool was needed to optimise performance. Meal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital‐acquired malnutrition.
Publisher: Wiley
Date: 14-07-2017
DOI: 10.1111/JHN.12397
Abstract: To improve perceived value of nutrition support and patient outcomes, the present study aimed to determine the nutrition and food-related roles, experiences and support needs of female family carers of community-dwelling malnourished older adults admitted to rehabilitation units in rural New South Wales, Australia, both during admission and following discharge. Four female family carers of malnourished rehabilitation patients aged ≥65 years were interviewed during their care-recipients' rehabilitation admission and again at 2 weeks post-discharge. The semi-structured interviews were audiotaped, transcribed and analysed reflecting an interpretative phenomenological approach by three researchers. A series of 'drivers' relevant to the research question were agreed upon and discussed. Three drivers were identified. 'Responsibility' was related to the agency who assumed responsibility for providing nutrition support and understanding family carer obligation to provide nutrition support. 'Family carer nutrition ethos' was related to how carer nutrition beliefs, knowledge and values impacted the nutrition support they provided, the high self-efficacy of family carers and an incongruence with an evidence-based approach for treating malnutrition. 'Quality of life' was related to the carers' focus upon quality of life as a nutrition strategy and outcome for their care-recipients, as well as how nutrition support impacted upon carer burden. Rehabilitation units and rehabilitation dietitians should recognise and support family carers of malnourished patients, which may ultimately lead to an improved perceived benefit of care and patient outcomes. Intervention research is required to make strong recommendations for practice.
Publisher: Wiley
Date: 26-01-2018
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.JAND.2015.06.012
Abstract: Nutrition screening is required for early identification and treatment of patients at risk for malnutrition so that clinical outcomes can be improved and health care costs reduced. To determine the criterion (concurrent and predictive) validity of the Malnutrition Screening Tool (MST) and Mini Nutritional Assessment-Short Form (MNA-SF) in older adults admitted to inpatient rehabilitation facilities. Observational, prospective cohort. Participants were 57 adults aged 65 years and older (mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. MST MNA-SF International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition rehospitalization admission to a residential aged care facility (institutionalization) and discharge location. Measures of diagnostic accuracy with 95% CIs generated from a contingency table, Mann-Whitney U test, and χ(2) test. When compared with the ICD-10-AM criteria, the MST showed stronger diagnostic accuracy (sensitivity 80.8%, specificity 67.7%) than the MNA-SF (sensitivity 100%, specificity 22.6%). Neither the MST nor the MNA-SF was able to predict rehospitalization, institutionalization, or discharge location. The MST showed good concurrent validity and can be considered an appropriate nutrition screening tool in geriatric rehabilitation. The MNA-SF may overestimate the risk of malnutrition in this population. The predictive validity could not be established for either screening tool.
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.JAND.2015.06.013
Abstract: Accurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously. In malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition. Observational, prospective cohort. Participants were 57 older adults (65 years and older mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia. Scored PG-SGA MNA and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity. Malnutrition prevalence varied according to assessment tool (ICD-10-AM: 46% Scored PG-SGA: 53% MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential aged care facility, and discharge to hospital or residential aged care facility instead of home. Malnutrition prevalence in the geriatric rural rehabilitation population is high, and is associated with increased health and aged care use. The Scored PG-SGA ratings and score are suitable for nutrition assessment in geriatric rehabilitation. The MNA may be suitable for nutrition assessment in geriatric rehabilitation, but care should be taken to ensure all malnourished patients are identified. Additional examination of the criterion validity of the Scored PG-SGA and MNA will lend confidence to these findings.
Publisher: Wiley
Date: 24-02-2011
No related grants have been discovered for Adrienne Young.