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Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored. An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory. Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals. PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings. Understanding what matters to patients in rehabilitation was reported as essential in person-centred nutrition care (PCNC), however varying degrees of this were observed in practice, with tensions exposed between the priorities of patients and staff. Collaborative goal setting is needed to enact PCNC, placing the patient at the centre of the process, rather than focusing on pre-determined, profession-specific agendas. However, reorientating this process must coincide with consideration of influencing systems, service priorities and cultures. Nutrition and mealtime-related goals of patients should be communicated not only within clinical teams, but also with dietetic support staff to better inform interprofessional practice and PCNC. Opportunities exist to better connect nutrition and dietetic services with the broader goals and objectives of rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co‐design of new mealtime interventions. Methods: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo‐elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. Results: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. Conclusions: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co‐design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. Practice Implications: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co‐designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. Impact: What problem did the study address?: Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require.Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings?: Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re‐prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal.There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement.Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact?: The research provides a framework for multidisciplinary teams to begin co‐designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. Reporting Method: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. Patient or Public Contribution: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript). [ABSTRACT FROM AUTHOR]

Background: Patient centred care (PCC) positively influences individual 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. Methods: 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 individual consultations with adult patients undertaking subacute rehabilitation. Results: 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, 'individualised care', 'tailored advice', 'follow‐up' and 'team collaboration'. Conclusions: 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 individualising interventions or organising ongoing services. This raises the question: is the delivery of nutrition care in subacute rehabilitation unit's patient centred? [ABSTRACT FROM AUTHOR]

Predicting and valuing potential rewards requires integrating sensory, associative, and contextual information with subjective reward preferences. Previous work has identified regions in the prefrontal cortex and medial temporal lobe believed to be important for each of these functions. For example, activity in the orbital prefrontal cortex (PFo) encodes the specific sensory properties of and preferences for rewards, while activity in the rhinal cortex (Rh) encodes stimulus-stimulus and stimulus-reward associations. Lesions of either structure impair the ability to use visual cues or the history of previous reinforcement to value expected rewards. These areas are linked via reciprocal connections, suggesting it might be their interaction that is critical for estimating expected value. To test this hypothesis, we interrupted direct, intra-hemispheric PFo-Rh interaction in monkeys by performing crossed unilateral ablations of these regions (func-tional disconnection). We asked whether this circuit is crucial primarily for cue-reward association or for estimating expected value per se, by testing these monkeys, as well as intact controls, on tasks in which expected value was either visually cued or had to be inferred from block-wise changes in reward size in uncued trials. Functional disconnection significantly affected performance in both tasks. Specifi-cally, monkeys with functional disconnection showed less of a difference in error rates and reaction times across reward sizes, in some cases behaving as if they expected rewards to be of equal magnitude. These results support a model whereby information about rewards signaled in PFo is combined with associative and contextual information signaled within Rh to estimate expected value. [ABSTRACT FROM AUTHOR]

Inhumansand other animals, the vigor with which a reward is pursued depends on its desirability, that is, on the reward's predicted value. Predicted value is generally context-dependent, varying according to the value of rewards obtained in the recent and distant past. Signals related to reward prediction and valuation are believed to be encoded in a circuit centered around midbrain dopamine neurons and their targets in the prefrontal cortex and basal ganglia. Notably absent from this hypothesized reward pathway are dopaminergic targets in the medial temporal lobe. Here we show that a key part of the medial temporal lobe memory system previously reported to be important for sensory mnemonic and perceptual processing, the rhinal cortex (Rh), is required for using memories of previous reward values to predict the value of forthcoming rewards. We tested monkeys with bilateral Rh lesions on a task in which reward size varied across blocks of uncued trials. In this experiment, the only cues for predicting current reward value are the sizes of rewards delivered in previous blocks. Unexpectedly, monkeys with Rh ablations, but not intact controls, were insensitive to differences in predicted reward, responding as if they expected all rewards to be of equal magnitude. Thus, it appears that Rh is critical for using memory of previous rewards to predict the value of forthcoming rewards. These results are in agreement with accumulating evidence that Rh is critical for establishing the relationships between temporally interleaved events, which is a key element of episodic memory. [ABSTRACT FROM AUTHOR]

Objectives: 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., Design: Three-round e-Delphi exercise, followed by consensus meetings., Setting: Multicentre study in Brisbane, Australia., Participants: 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., Methods: 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., Results: 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., Conclusions: 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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)