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Purpose: Nutrition care guidelines for the transgender population do not exist, despite significant nutrition-related clinical and psychosocial considerations. Social networking sites (SNSs) provide multidirectional communication and have expanded in popularity among transgender users as a resource for health information and support. The nature of the content shared among the online transgender community is unknown, but may suggest the nutrition-related areas that are of most importance to the transgender population. The objective of this qualitative netnography was to describe the food and nutrition messages shared among the transgender community using video blogs (vlogs) on the SNS, YouTube. Methods: Public vlogs were assessed using the constant comparative method. Pseudoquantitative methods were used to capture the prevalence of each subtheme; quotes were documented verbatim. Data were collected from transgender users' public vlogs (n=30) self-published on YouTube from 2013 to 2018. Results: Six major themes were generated from the data analysis. These included the following: functions of diet and exercise; diet and exercise philosophies; “how to” vlogs; advice for success; using dietary supplements; and effects of hormone therapy. Conclusions: Nutrition-related messages are widely shared among the online transgender community through YouTube. The identified themes reflect topics of interest and expressed needs of transgender individuals. SNSs provide health care providers with a platform to improve patient education and health literacy. Health care providers may actively engage in online discussions to build trust, answer questions, and provide a source of accurate and evidence-based information.

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.

An increasing prevalence of noncommunicable diseases (NCDs) and chronic illness is putting an ever increasing burden on healthcare services and delivery worldwide. Diet contributes significantly to the development of NCDs. Nutrition should therefore be viewed as an important aspect of patient care and be addressed by all healthcare professionals (HCPs). Previous work has highlighted a lack of competency around providing nutrition advice in HCPs; however, positive attitudes towards the importance of nutrition care are well documented in this group. The aim of this study is to document and compare Irish HCPs self-perceived competency towards incorporating nutrition care into practice. The NUTCOMP questionnaire was completed by 206 HCPs in Sligo University Hospital. The findings showed positive attitudes towards the incorporation of nutrition care into HCP practice; however, confidence in knowledge and skills was low, thus missing vital opportunities to prevent and/or treat chronic diseases and improve outcomes in acute illness. Previous nutrition education was associated with greater self-perceived knowledge about and skills in providing nutrition care to patients and positively associated with attitudes towards incorporating nutrition care into practice. HCPs expressed a desire and unmet need for additional and ongoing educational intervention in the area of nutritional intervention.

Background Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.

Summary Introduction Malnutrition is known as one of the major health problems among critically ill children; optimum nutrition support is considered as a therapeutic strategy to improve clinical outcomes and minimize the length of Pediatric Intensive Care Unit (PICU) staying as well as its costs. Implementation of an algorithmic protocol can result in the upgrade of the quality of nutrition support system in PICU. Method In this study, we developed a stepwise algorithmic nutrition care protocol for PICU patients in two phases as follows: a critical review of past literature and an expert discussion panel. The final structured protocol includes three following steps for the nutrition care process: 1) Initial nutrition screening and assessment, 2) Nutritional intervention and 3) Nutritional monitoring. Pre and post-implementation audits were carried out in a 23 bed medical/surgical PICU in a children's hospital affiliated to Mashhad University of Medical Sciences over two 4-week periods to evaluate the impact of the algorithm implementation. The post-implementation audit was performed by passing 12 weeks from the protocol implementation. Critically ill children aged between 1month and 10 years, and PICU length of stay>24 h who were in post gastrointestinal surgery state, were enrolled. Results Totally, 34 eligible critically ill gastrointestinal surgical children in post-implementation audit were compared with 30 patients with similar eligibility criteria in the pre-implementation audit. Notably, there were no significant differences in gender, median age, length of PICU stay, and mechanical ventilation requirement in the two audits. The comparison of our pre and post-implementation audits showed a significant increase in the proportion of energy delivery goal achievement following performing our intervention (56.7%, and 85.3%, for pre and post-implementation audits, respectively; p-value = 0.01).Additionally, time of achieving energy and protein goals were significantly decreased (5.5 vs. 3 days; p-value = 0.008 and 4 vs 3 days; p-value = 0.002, for energy and protein delivery goal achievements, respectively). Conclusion The implementation of the algorithm have significantly improved the adequacy ratio of energy delivery and also decreased the time to achieve the goal in energy and protein intake among critically ill children in post-gastrointestinal state. In this regard, further prospective studies are needed for continuing the evaluation of the algorithm implementation outcomes in critically ill children with different surgical and internal underlying diseases.

Background we evaluated medical doctors’ nutrition care practices, competencies and barriers to providing nutrition care. Furthermore, doctors’ satisfaction and perceived adequacy of their nutrition education as well as the use and effectiveness of training and learning resources for continuing nutrition education were also investigated.methodsthis cross-sectional study included medical doctors working at various levels of care in ghana who responded to either an online or paper-based survey. Appropriate statistical tools were used to analyse the data.resultsmajority (70%) of the 114 doctors who responded to the survey estimated that more than 60% of their patients needed nutrition care. However, only = 40% received such care. More than 80% of doctors referred patients to dieticians/nutritionists. Comfort levels correlated positively (r = 0.288; p = 0.002) with attitudes about nutrition care. The most common barriers to nutrition care were lack of time (79%), inadequate knowledge (78.6%) and counselling skills (68.4%). About 66% perceived their nutrition education in medical school to be inadequate, and more than 70% were either unsatisfied or undecided with their nutrition educational experiences. Perceived adequacy (r = 0.200; p = 0.016) and satisfaction with nutrition education (r = 0.218; p = 0.002) were associated with doctors’ comfort levels. Only 30% were currently using a nutrition-related learning resource for continuing education in nutrition.conclusiondoctors felt their patients required more nutrition care than they could provide. Their nutrition care was hindered by lack of time, inadequate knowledge, confidence and counselling skills. Educational interventions that improve on medical doctors’ attitudes and comfort levels in providing nutrition care may be needed.

Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes.Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013-2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications.A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%-61%), early postoperative oral feeding (P .001), and mobilization (P .001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11-3.64; P .001) and a trend for LOS5 days (OR 1.40; 95% CI, 1.00-1.96; P = .052). Low compliance to ERAS (70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23-3.24; P .001).ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.

Goals The goal of this study was to develop a multi-disciplinary consensus of nutrition care priorities for implementation in an IBD nutrition center of excellence (COE). Background The role for nutrition care in inflammatory bowel disease is broad and encompasses multiple domains. Gaps exist in the published literature around best nutrition care practices in inflammatory bowel disease and highlight the need for an evidence based approach acceptable to patients, and generalizable to a wide inflammatory bowel disease population. Study Twelve health leaders in inflammatory bowel disease care attended a 1-day retreat. Two focus groups were completed using traditional focus group methodology for the first half of the retreat and a World Café method for the second half. Data analysis included review of analytic memos and conceptual analysis completed at the time of discussion, theme identification and team consensus for conceptual development. Results Three primary themes were identified as the main pillars of a COE in an IBD nutrition center of excellence. These include: a) excellence in clinical care, b) novel discovery and research, and c) knowledge translation to patients and practitioners. The key initial steps identified in this study included standardizing malnutrition screening and support while creating an environment where nutrition therapy is included as a standard of care, developing and examining the effectiveness of novel diet therapies, and translating knowledge to build capacity among care providers and patients. Conclusions Using a 1-day retreat to identify a future direction for a center focused on nutrition excellence and align our coalition towards common goals was a successful strategy to develop consensus and identify nutrition care priorities for action.

Objective To examine the effect of an adapted simulated patient (SP) intervention on self-efficacy in nutrition care process skills. Design A repeated-measures design using a 25-item survey divided into 7 nutrition professional practice competencies (PPCs) employing a 5-point self-efficacy scale (1 = lowest to 5 = highest) administered immediately before and after the intervention. Setting A private Japanese university. Participants Ninety Japanese third-year dietetics undergraduates aged 20–38 years. Intervention An adapted SP activity practicing nutrition care process skills for the infirm elderly population. Main Outcome Measures Pre- to postintervention self-efficacy response scores and feedback. Analysis Mean preintervention survey scores were used to divide participants into statistical quartiles (Q1 indicated lowest mean scores and Q3, highest mean scores). Wilcoxon signed-rank tests compared each PPC's pre- and postintervention means. Kruskal-Wallis tests examined changes in quartiles' scores within each PPC. Results Self-efficacy improved significantly in PPCs relating to application of appropriate medical ethics and interpersonal skills (P = .02), appropriate nutrition assessment (P = .04), and creation of a nutrition management plan and nutrition intervention (P = .03). Self-efficacy of Q1 and Q2 rose significantly in most PPCs, although not for acting as a dietitian within a medical care team, whereas that of Q3 decreased for all PPCs. Conclusions and Implications Among initially low self-efficacy dietetics undergraduates, the SP intervention enhanced self-efficacy in 3 of the 6 PPCs practiced directly and may facilitate more realistic self-views among initially high self-efficacy students. However, further research in the design, implementation, and efficacy of this type of training is recommended to gauge its effects on the quality of related professional practice.

Objectives: This study aimed to evaluate nutrition care and nursing professional knowledge received by adults on highly active antiretroviral therapy attending primary health care (PHC) facilitiesD...

Background and objective Traditional nutrition evaluations not only require the use of numerous tables and lists to provide sufficient recommendations for patients’ diets but are also very time-consuming due to cross-referencing and calculations. Methods To personalize patient assessments, this study implemented a Clinical Nutritional Information System (CNIS) to help hospital dietitians perform their daily work more effectively in terms of time management and paper work. The CNIS mainly targets in-patients who require cancer-nutrition counselling. The development of the CNIS occurred in three phases. Phase 1 included system design and implementation based on the Nutrition Care Process and Model (NCPM) and the Patient Nutrition Care Process. Phase 2 involved a survey to characterize the efficiency, quality and accuracy of the CNIS. In Phase 3, a second survey was conducted to determine how well dietitians had adapted to the system and the extent of improvement in efficiency after the CNIS had been available online for three years. Results The work time requirements decreased by approximately 58% with the assistance of the CNIS. Of the dietitians who used the CNIS, 95% reported satisfaction, with 91.66% indicating that the CNIS was really helpful in their work. However, some shortcomings were also evident according to the results. Conclusions Dietitians favoured the standardization of nutritional intervention and monitoring. The CNIS meets the needs of dietitians by increasing the quality of nutritional interventions by providing accurate calculations and cross-referencing for information regarding patients’ conditions, with the benefit of decreasing the processing time, such as handwritten documentation. In addition, the CNIS also helps dietitians statistically analyse each patient's personal nutritional needs to achieve nutritional improvement.

Provision of adequate protein is crucial for optimizing outcomes in hospitalized patients. However, the methodologies upon which current recommendations are based have limitations, and little is known about true requirements in any clinical population. In this tutorial, we aim to give clinicians an understanding of how current protein recommendations were developed, an appreciation for the limitations of these recommendations, and an overview of more sophisticated approaches that can be applied to better define protein requirements. A broader perspective of the challenges and opportunities in determining clinical protein requirements can help clinicians think critically about the individualized nutrition care they provide to their patients with the goal of administering adequate protein to optimize outcomes.

The prevalence of malnutrition in Indonesia in the last 20 years remains high. This shows that management through curative aspects is not enough. A new strategy is needed to solve the problem as well as to overcome the risk factors. The root cause of malnutrition in Indonesia is the lack of maternal knowledge and power towards their nutrition status. This study aims to determine the mentoring that To do through a tutorial module on malnutrition risk factors. This expects to empower mothers on caring for 6-60 months old children. This research is a two-sample experimental study with controls. Respondents were mothers who had children aged 6-60 months. A total of 39 mothers choose a control group and 38 mothers as a treatment group. The mentoring method was given to the treatment group while providing counseling to the control group: multivariate ANOVA and independent t-tests to show maternal empowerment. Mentoring on caregiving was very effective in increasing mothers’ abilities to care for their children’s nutrition (p

Цель: изучение клинической эффективности применения пробиотического комплекса — закваски Бифидокомплекс ТМ GOODFOOD для диетической коррекции у детей с нарушением питания.Материалы и методы. Под наблюдением находился 31 ребенок в возрасте от одного до трех лет с нарушением питания. Контрольную группу составили 20 практически здоровых детей, физическое развитие которых соответствовало возрасту. Проведено анамнестическое, клиническое, лабораторное и инструментальное исследование. Для диетической коррекции у детей с нарушением питание использовалась сухая бактериальная закваска Бифидокомплекс ТМ GOODFOOD.Результаты. У детей, получавших кисломолочный продукт, заквашенный на основе сухой бактериальной закваски Бифидокомплекс ТМ GOODFOOD, определялась нормализация микрофлоры кишечника, улучшение показателей физического развития и повышение иммунитета.Выводы. Ферментированные пробиотические продукты на основе бактериальной закваски Бифидокомплекс ТМ GOODFOOD могут быть успешной альтернативой пробиотическим препаратам, которые применяются с целью диетической коррекции у детей., Objective: to study the clinical efficacy of the probiotic complex usage Bifidocomplex fermentation starter, produced by the manufacturer TM GOODFOOD for nutrition care in children with nutritional disorders.Material and methods. In total 31 children aged from 1 to 3 years old with dysnutrition were under observation during 2015–2016. The control group comprised 20 apparently health children whose physical development corresponded to their age. Anamnestic, clinical, laboratory and instrumental research was conducted. A dry fermentation starter Bifidocomplex (TM Good Food) was used for nutrition care in children with nutritional disorders.Results. There were observed intestinal microflora normalization, physical development and immunity improvement in children who received fermented dairy food, soured by means of the dry fermentation starter Bifidocomplex (TM GOODFOOD).Conclusions. Fermented probiotic products based on fermentation starter Bifidocomplex (TM Good Food) can be a successful alternative to probiotic drugs used for nutrition care in children., Мета: вивчення клінічної ефективності застосування пробіотичного комплексу — закваски Біфідокомплекс ТМ GOODFOOD для дієтичної корекції у дітей з порушенням харчування.Матеріали і методи. Під спостереженням знаходилася 31 дитина віком від одного до трьох років з порушенням харчування. Контрольну групу склали 20 практично здорових дітей, фізичний розвиток яких відповідав віку. Проведено анамнестичне, клінічне, лабораторне та інструментальне дослідження. Для дієтичної корекції у дітей з порушенням харчування використовувалася суха бактеріальна закваска Біфідокомплекс ТМ GOODFOOD.Результати. У дітей, які отримували кисломолочний продукт, заквашений на основі сухої бактеріальної закваски Біфідокомплекс ТМ GOODFOOD, визначалися нормалізація мікрофлори кишечника, покращання показників фізичного розвитку та підвищення імунітету.Висновки. Ферментовані пробіотичні продукти на основі бактеріальної закваски Біфідокомплекс ТМ GOODFOOD можуть бути успішною альтернативою пробіотичним препаратам, які застосовуються з метою дієтичної корекції у дітей.

49 Background: Oncology providers and patients benefit from evidence-based nutritional resources to support cancer care. For patients, proper nutrition care can prevent inappropriate weight loss, improve treatment tolerance, and improve quality of life. Recent literature has noted the lack of both adequate dietitian resources at outpatient centers and comprehensive nutrition guidelines in cancer care. At a large community practice with 210 locations across Texas and Oklahoma, a survey was developed and administered to assess nutrition practices. Methods: Clinic directors in the practice completed a survey to assess for the presence or absence of a malnutrition screen; how nutrition concerns are addressed; and the availability of a dietitian. Results: A total of 26 responses detailed the nutrition processes at 50 unique locations. At 37 (74%) locations, a malnutrition screening tool was utilized and of these, 30 (81%) locations reported utilizing the Malnutrition Screening Tool (MST), a brief, validated tool for outpatient settings including oncology. Seven (19%) sites did not specify what tool was used. Of the clinics that reported completing a malnutrition screen for patients, the screen was completed by the advanced practice provider (APP)/physician in 18 (49%) clinics, a nurse in 4 (11%) clinics, a dietitian in 4 (11%) clinics and a medical assistant in 1 (3%) clinic. At 10 sites more than one provider type was responsible for completing the screen. Nutrition issues were addressed by physicians, APPs, and nurses in 15 (50%), 35 (70%), and 9 (14%) sites respectively (see table). Twenty-two locations (44%) reported referring patients to a dietitian and 10 sites (20%) had a dietitian available in clinic. Forty-one (82%) clinics employed more than one method for addressing nutrition issues. Sixteen of 26 respondents (62%) reported that increased dietitian access would be helpful; this included respondents whose locations already had a dietitian available. Conclusions: Overall, 74% of reporting locations used a malnutrition screening tool and 20% had access to a dietitian on site. Forty-four percent of sites referred to a dietitian if there was a need. This indicates that multiple providers are involved in the nutritional care of oncology patients. In response to these findings, the multidisciplinary PECAN Taskforce was created to develop comprehensive malnutrition screening, implement a referral process for all at-risk patients, enhance nutrition education, and expand dietitian services. Further study will measure the impact of expanded nutrition access on patient outcomes.[Table: see text]

Background Studies suggest cooking skill-based learning increases knowledge and improves nutrition attitudes and confidence more than traditional knowledge-based approaches. Current educational strategies may not adequately prepare future healthcare professionals to become empathetic and innovative problem-solvers who have the skills to provide evidence-based and practical advice about nutrition. Objective The objective of this study was to investigate how a culinary medicine course for pre-health profession college students impacts nutrition care attitudes. Study Design, Setting, Participants Twenty-five pre-health profession undergraduate students enrolled in an interprofessional, experiential culinary medicine course participated. This was a skills- and case-based course which focused on food and cooking, and evidence-based nutrition recommendations for chronic disease. Measurable Outcome/Analysis Items from the validated Nutrition in Patient Care Survey (NIPS) were administered pre-post course completion to assess nutrition care attitudes. Sociodemographic characteristics such as age, year in college, career aspirations, race, and ethnicity were collected. Data were analyzed using descriptive statistics, paired t tests, Wilcoxon signed rank tests, and ANOVA with post hoc analysis. Results Baseline attitudes scores were somewhat high compared to literature from working health professionals. No significant changes were seen in attitude scores, but differences were found based on ethnicity and career aspirations. Students identifying as Hispanic had more negative attitudes regarding nutrition counseling (P = 0.001) and including nutrition in routine patient care (P = 0.013), but had more positive attitudes towards the importance of taste in improving dietary patterns (P = 0.002). Aspiring doctors, dentists, and physician assistants had more negative attitudes about nutrition counseling than future dietitians (P = 0.008) and nurses (P = 0.049). Conclusion Although no significant changes were found in attitude scores, the differences based on ethnicity and career aspirations warrant further investigation. Nutrition care is incidental to many health professionals’ practice. Strategies to cultivate positive attitudes regarding the role of nutrition across health disciplines should be identified to better develop competency.

Good nutritional support is crucial for the immune system to fight against coronavirus disease 2019 (COVID-19). However, in the context of a pandemic with a highly transmissible coronavirus, implementation of nutrition practice may be difficult. A multicenter electronic survey involving 62 dieticians was conducted, in order to understand barriers associated with dieticians’ adherence to nutrition guidelines for hospitalized COVID-19 patients in Indonesia. 69% of dieticians felt under stress when performing nutrition care, and 90% took supplements to boost their own immunity against the coronavirus. The concerns related to clinical practice included a lack of clear guidelines (74%), a lack of access to medical records (55%), inadequate experience or knowledge (48%), and a lack of self-efficacy/confidence (29%) in performing nutritional care. Half (52%) of the dieticians had performed nutrition education/counseling, 47% had monitored a patient’s body weight, and 76% had monitored a patient’s dietary intake. An adjusted linear regression showed that guideline adherence independently predicted the dieticians’ nutrition care behaviors of nutrition counselling (ß: 0.24 (0.002, 0.08), p = 0.04), and monitoring of body weight (ß: 0.43 (0.04, 0.11), p = 0.001) and dietary intake (ß: 0.47(0.03, 0.10), p = 0.001) of COVID-19 patients. Overall, adherence to COVID-19 nutrition guidelines is associated with better nutritional management behaviors in hospitalized COVID-19 patients.

Background : Hyperemesis gravidarum is a condition of nausea and vomiting that causes weight loss in pregnant women. Hyperemesis can cause malnutrition in the mother and affect the fetus and risk causing death. Purpose : The purpose of writing is to provide a comprehensive description of nutritional care for pregnant women with hyperemesis gravidarum using the literature review method. From the study, it is known the importance of proper nutritional care for mothers with hyperemesis gravidarum in the form of a cycle of assessment, nutritional diagnosis, intervention, monitoring and evaluation which are carried out continuously to overcome the problem of hyperemesis gravidarum in collaboration with the nutrition care team. Conclusion : The conclusion is that nutritional care with a comprehensive understanding of the problem of hyperemesis gravidarum in the form of cross-professions collaboration will improve the nutritional status of mothers.

Background: Patient-centred care (PCC) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC. We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations. Methods: The present study used qualitative methods, situated in a constructivist–interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi-structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically. Results: Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health. Conclusions: PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient-centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC. By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient-centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

Approximately 3% to 4% of women are pregnant upon their admission to prison. Pregnant inmates present unique challenges for correctional health providers, including meeting the nutritional needs for healthy pregnancy outcomes. The authors outline six recommendations for nutrition care for pregnant inmates, including (1) test for pregnancy; (2) prescribe prenatal vitamins; (3) follow nutrition recommendations outlined by the Academy of Nutrition and Dietetics; (4) provide additional food, monitor over time, and allow for modifications to meet pregnancy needs; (5) ensure regular access to water; and (6) provide inmates with resources and education on healthy diet. The degree to which correctional facilities address the nutritional needs of pregnant women may have short- and long-term consequences for the health of women and their offspring.

This study used a mixed methods design to explore factors that affect food choices and nutrition care in rural Appalachian people. Ten registered dietitians, 10 graduate dietetic interns, and 10 ru...

The provision of nutrition care by health professionals can facilitate improved patient nutrition behaviors. Some education institutions include nutrition in their medical curriculum; however, doctors and medical students continue to lack competence in providing nutrition care. Dietitians are increasingly teaching nutrition to medical students, yet evidence on the topic remains anecdotal. It is important to understand the experiences of these dietitians to support improvements in undergraduate medical nutrition education. The aim of this study was to explore dietitians' perspectives of teaching nutrition to medical students.A qualitative study was conducted in collaboration with the Need for Nutrition Education/Innovation Programme (NNEdPro). Twenty-four dietitians who had provided nutrition education to medical students participated in individual semistructured interviews. Participants were from Australia (n = 5), New Zealand (n = 1), the United States (n = 6), Canada (n = 5), the United Kingdom (n = 5), Germany (n = 1), and Finland (n = 1). Data analysis was conducted using a constant comparative approach to thematic analysis.The dietitians expressed confidence in their ability to teach medical students and believed that they were the most appropriate professionals to administer the education. However, they were not confident that medical students graduate with sufficient nutrition competence and attributed this to poor curriculum planning for nutrition. Dietitians had access to useful resources and tools to support education, with opportunity to contribute further to integration of nutrition throughout medical curricula.This study suggests that dietitians are likely appropriate nutrition teachers in medical education. However, optimizing dietitians' role requires their further involvement in curriculum planning and development. Including dietitians as members of medical faculty would facilitate their input on nutrition throughout the curriculum, which could enhance the nutrition education of medical students.

Kristen K Hicks,Peter S Murano Texas A&M University, Department of Nutrition and Food Science, College Station, TX, USA Objective: The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. Methods: A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association’s education library, available to all physicians. Results: Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME (P

Background Doctors are in a good position to provide nutrition advice to patients. However, doctors and medical students find their nutrition education to be inadequate. We evaluated nutrition-related knowledge, attitudes and self-efficacy in a sample of future doctors. Furthermore, we investigated the association between nutrition-related knowledge, attitude and self-efficacy. We also compared nutrition-related knowledge, attitudes and self-efficacy with level of clinical training. Methods Following a cross-sectional design, the nutrition-related knowledge, attitudes and self-efficacy of 207 undergraduate clinical-level medical students (referred to as future doctors) was measured using a questionnaire. Items of the questionnaire were derived from previously validated survey instruments. Descriptive statistics of mean and standard deviation was used to describe the data. Results Future doctors had a mean knowledge score of 64%. Their mean knowledge scores in the nutrition topics assessed were 41% for ‘malnutrition in children’, 59% for ‘diabetes and obesity’ and 73% for ‘nutrients, energy and their deficiencies’. Future doctors’ attitudes towards nutrition care were generally positive but were uncertain in the effectiveness of health education in changing the lifestyle of patients. They felt inadequate in their self-efficacy to provide nutrition care. Attitudes towards nutrition care correlated (r = 0.371, p < 0.001) positively with self-efficacy to provide nutrition care. Level of clinical training was associated to nutrition-related knowledge of the students. Conclusion Future doctors had positive attitudes towards nutrition care but showed important knowledge gaps and also felt inadequate in their confidence to provide nutrition care. Attitudes may be important in nutrition care self-efficacy.

Background: The management of patients with enterocutaneous fistula (ECF) requires an interdisciplinary approach and poses a significant challenge to physicians, wound/stoma care specialists, dietitians, pharmacists, and other nutrition clinicians. Guidelines for optimizing nutrition status in these patients are often vague, based on limited and dated clinical studies, and typically rely on individual institutional or clinician experience. Specific nutrient requirements, appropriate route of feeding, role of immune-enhancing formulas, and use of somatostatin analogues in the management of patients with ECF are not well defined. The purpose of this clinical guideline is to develop recommendations for the nutrition care of adult patients with ECF. Methods: A systematic review of the best available evidence to answer a series of questions regarding clinical management of adults with ECF was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evalu...

Background Home parenteral nutrition (HPN) is a high-cost, complex nutrition support therapy that requires the use of central venous catheters. Central line-associated bloodstream infections (CLABSIs) are among the most serious risks of this therapy. Sustain: American Society for Parenteral and Enteral Nutrition's National Patient Registry for Nutrition Care (Sustain registry) provides the most current and comprehensive data for studying CLABSI among a national cohort of HPN patients in the United States. This is the first Sustain registry report detailing longitudinal data on CLABSI among HPN patients. Objective To describe CLABSI rates for HPN patients followed in the Sustain registry from 2011-2014. Methods Descriptive, χ 2 , and t tests were used to analyze data from the Sustain registry. Results Of the 1,046 HPN patients from 29 sites across the United States, 112 (10.7%) experienced 194 CLABSI events during 223,493 days of HPN exposure, for an overall CLABSI rate of 0.87 episodes/1,000 parenteral nutrition-days. Although the majority of patients were female (59%), adult (87%), white (75%), and with private insurance or Medicare (69%), CLABSI episodes per 1,000 parenteral nutrition-days were higher for men (0.69 vs 0.38), children (1.17 vs 0.35), blacks (0.91 vs 0.41), and Medicaid recipients (1.0 vs 0.38 or 0.39). Patients with implanted ports or double-lumen catheters also had more CLABSIs than those with peripherally inserted or central catheters or single-lumen catheters. Staphylococci were the most commonly reported pathogens. These data support findings of smaller studies about CLABSI risk for children and by catheter type and identify new potential risk factors, including gender, race, and insurance type. Conclusions Additional studies are needed to determine effective interventions that will reduce HPN-associated CLABSI.

Objectives To investigate the intention of fitness businesses to promote the provision of nutrition care from personal trainers. Study design Cross-sectional evaluation of webpage content. Methods Fitness businesses within two Australian federal electorates were identified using the Fitness Australia list of registered fitness businesses. Inductive content analysis of these fitness business websites and associated social media sites was undertaken to compare website content to the Fitness Australia Position Statement outlining the Roles and Responsibilities of Registered Fitness Professionals. Fitness businesses were classified as ‘within scope of practice’ if they referred to national nutrition guidelines or dietetic services. ‘At risk of being beyond scope’ included websites which did not include enough information to definitively state within or beyond scope. Fitness businesses were classified as ‘definitely beyond scope of practice’ if they advertised nutrition care which clearly extended beyond translation of the national dietary guidelines. Results Of the businesses reviewed, 15% were within scope despite none referring to a dietitian; 34% were at risk of being beyond scope; and 51% were beyond scope as they advertised nutrition care such as personalized diets without indicating dietetic input. Conclusions A considerable portion of fitness businesses reviewed advertised their personal trainers as able to provide nutrition care outside the recommended scope of practice. Strategies that help fitness businesses and personal trainers to support clients to have healthy dietary behaviours without extending outside the scope of practice are warranted.

Nutrition Day je međunarodni stručno – znanstveni projekt kojemu je cilj poboljšanje znanja i svijesti o važnosti pravilne prehrane u bolnicama, a čiji začetnik je Europsko društvo za kliničku prehranu i metabolizam (ESPEN). 15. i 16. studenog 2018. godine u ovome projektu sudjelovao je KBC Zagreb. Cilj ovog projekta je povećati svijest o važnosti pravilne prehrane bolesnika među pacijentima, ali i među medicinskim osobljem, dok je cilj ovog diplomskog rada bio obraditi podatke dobivene prikupljanjem tijekom Nutrition Day-a 2018. u KBC Zagreb te ih usporediti s referentnim rezultatima prikupljenim u drugim zemljama. Provođenje projekta i ispunjavanje upitnika organizirali su i proveli djelatnici Odjela za kliničku prehranu i nutricionisti Službe za prehranu i dijetetiku, uz pomoć dvadesetak volontera, studenata nutricionizma i medicine. Rezultati su ukazali na manji broj zaposlenih dijetetičara i nutricionista, prisutnost nutritivne strategije i nutritivne njege, međutim nedostatak aktivnosti vezan uz probir malnutricije. Tjelesna masa najčešće se mjeri pri prijemu o bolnicu, a gotovo nikada tijekom 24, 48 ili 72 h. Također za procjenu i praćenje malnutricije se najčešće koristi vaganje ili samo podatak o ITM-u. KBC Zagreb nastoji paziti na odgovarajući unos energije svojih pacijenata. Nutrition Day is an international professionally- scientific project aimed at improving the knowledge and awareness of the importance of proper nutrition in hospitals, initiated by the European Society for Clinical Nutrition and Metabolism (ESPEN). In November 15 and 16, 2018 CHC Zagreb participated in this project. The aim of this project is to raise awareness of the importance of proper nutrition for patients, as well as among medical staff, while the aim of this graduate thesis was to process the data collected during Nutrition Day 2018 at CHC Zagreb and compare them with the reference results collected in other countries. The implementation of the project and the completion of the questionnaire were organized and conducted by the staff of the Department of Clinical Nutrition and Nutritionists of the Nutrition and Dietetics Department, with the assistance of twenty volunteers, students of nutrition and medicine. The results showed a low number of employed dietitians and nutritionists, the presence of nutritional strategy and nutritional care, however, there was a lack of activity related to malnutrition screening. Body weight is most commonly measured at admission in hospital and almost never during 24, 48 or 72 hours. Also, weighing or just BMI data is most commonly used to evaluate and monitor malnutrition. CHC Zagreb strives to ensure that its patients have adequate energy intake.

In the US healthcare system, malnutrition is a common condition, yet it remains underreported and underdiagnosed. The financial costs of disease-associated malnutrition are substantial; hospital-acquired conditions, readmissions, and prolonged lengths of stay are reported to cost as much as $150 billion per year. By contrast, nutrition-focused quality improvement programs for inpatients can help reduce the negative impact of disease-associated malnutrition. Such programs include systematic screening for malnutrition risk on admission, timely malnutrition diagnoses, and prompt nutrition interventions, which have been shown to lower rates of hospital-acquired infections, shorten lengths of stay, reduce readmissions, and lessen costs of care. Nurses are ideally positioned to play critical roles in nutrition-related care-screening for malnutrition on admission, monitoring for and addressing conditions that impede nutrition intake, and ensuring that prescribed nutrition interventions are delivered and administered or consumed. Such nursing support of multidisciplinary nutrition care contributes to better patient outcomes at lower costs.

This study aimed to examine nutrition care management for in-patients with dysphagia and to evaluate knowledge on nutrition care related to dysphagia among dietitians in clinical settings. A total of 554 questionnaires were distributed to dietitians at hospitals located in Seoul and Gyeonggi Province in Korea, and 147 responses were used for data analysis after excluding responses with significant missing data. Study participants worked at general hospitals (37.2%), long-term care hospitals (24.3%), hospitals (19.2%), and tertiary hospitals (11.5%). Prior education and training related to dysphagia was received by 69.9% of the respondents. The percentage of hospitals that had diet guidelines for dysphagia was 68.0%. Dysphagia diets of 2 levels and 3 levels were provided in 55.1% and 34.7% of the hospitals, respectively. Overall 74.7% of the dietitians responded that they provided information on dysphagia diets to in-patients and caregivers, but only 45.7% of dietitians did so in the long-term care hospitals. Among the respondents who used commercial thickening agents, 77.2% used only one type of commercial thickening agent. Patients or caregivers (75.7%) or nurses (34.5%) were reported to modify viscosity of liquid. Dietitians showed low levels of knowledge on nutrition care related to dysphagia (a mean of 5.14 based on possible scores from 0 to 10 points). To promote nutritional consumption and prevent malnutrition and aspiration, hospitals need the standardized diet guidelines, and dietitians should improve their expertise in nutritional care for patients with dysphagia.

Summary Background and aims The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently implemented by dietetics practitioners worldwide, with various advantages, including ensuring consistency and clarity of dietetics-related healthcare records and the possibility to collect and analyse patient outcomes; however, how Saudi dietitians experience the implementation process is poorly understood. The aim of this study was to explore the experiences of Saudi dietitians of NCP implementation in hospitals in Jeddah. Methods In this quantitative, cross-sectional study, 56 dietitians were recruited from six principal hospitals in Jeddah. A questionnaire was used to collect data on the characteristics of the dietitians and hospital-related clinical nutrition care performance, the perception and opinions of dietitians towards the NCP, and the status of NCP implementation. Results Almost all dietitians (98%) were aware of the NCP; however, only 27% had received NCP training. Most dietitians (73%) reported that their department currently follows the NCP, while only 26% reported using the standardized NCP, including International Classification of Functioning, Disability & Health – Dietetics (ICF-D)-WHO and International Dietetic & Nutrition Terminology (IDNT) – USA, with 63% following the hospital's own NCP. Reported reasons for hospitals not following the NCP included insufficient dietitians, lack of experience, or conflict with the hospital's nutrition care system. A majority of dietitians reported no perceived barriers to applying the NCP; however, 23% reported NCP documentation as a challenge. Conclusions The majority of dietitians are aware of the NCP and feel confident to practice; however, the NCP model is not currently implemented in Jeddah hospitals as standard. On-going education, a training program, and an implementation plan should be prioritised.

Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent Advances: Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Critical Issues: Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Future Directions: Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.

Cannabis has been used medicinally for thousands of years. Although the use of cannabis in its whole, natural form is prohibited in many countries, public interest in its medicinal use has increasingly led to its legalization for this purpose in several localities. Prescription cannabis-based pharmaceuticals have been developed and used for the management of nausea, vomiting, anorexia, muscle spasticity and pain. Available research suggests that both pharmaceutical and natural cannabinoids may provide relief of some of these conditions.