Malnutrition prevalence and burden among medical and surgical Vietnamese patients: opportunity for comprehensive nutrition care

This paper invites readers to consider how the ideals, concepts, and language of nutrition justice may be incorporated into the everyday practice of clinical dietitians whose work is often carried out within large, conservative, primary care institutions. How might clinical dietitians address the nutritional injustices that bring people to their practice, when practitioners are constrained by the limits of current diagnostic language, as well as the exigencies of their workplaces. In the first part of this paper, I draw on Cadieux and Slocum’s work on food justice to develop a conceptual framework for nutrition justice. I assert that a justice-oriented understanding of nutrition redresses inequities built in to the biomedicalization of nutrition and health, and seeks to trouble by whom and how these are defined. In the second part of this paper, I draw on the conceptual framework of nutrition justice to develop a politicized language framework that articulates nutrition problems as the outcome of nutritional injustices rather than individuals’ deficits of knowledge, willingness to change, or available resources. This language framework serves as a counterpoint to the current and widely accepted clinical language tool, the Nutrition Care Process Terminology, that exemplifies biomedicalized understandings of nutrition and health. Together, I propose that the conceptual and language frameworks I develop in this paper work together to foster what Croom and Kortegast (2018) call “critical professional praxis” within dietetics.

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Risk of Weight Loss in Adult Patients and the Effect of Staffing Registered Dietitians in Kaifukuki (Convalescent) Rehabilitation Wards: A Retrospective Analysis of a Nationwide Survey

Healthcare ◽

10.3390/healthcare9060753 ◽

2021 ◽

Vol 9 (6) ◽

pp. 753

Author(s):

Shinta Nishioka ◽

Yoji Kokura ◽

Takatsugu Okamoto ◽

Masako Takayama ◽

Ichiro Miyai

Keyword(s):

Weight Loss ◽

Odds Ratio ◽

Lower Risk ◽

Nationwide Survey ◽

Adult Patients ◽

Weight Class ◽

Registered Dietitians ◽

Lower Odds ◽

Nutrition Care ◽

Class 1

There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss.

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Perioperative nutrition care and dietetic practices in the scope of bariatric surgery in Saudi Arabia using adapted protocols for evaluation

SAGE Open Medicine ◽

10.1177/20503121211036136 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110361

Author(s):

Elham Abbas Aljaaly

Keyword(s):

Bariatric Surgery ◽

Saudi Arabia ◽

Care Process ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Nutrition Risk ◽

Nutrition Care ◽

Management Protocol ◽

Perioperative Nutrition

Objectives: This study evaluates the availability of perioperative nutritional care protocols and the practices of bariatric registered dietitians in Saudi Arabia. The primary outcomes of the study were conducted using an adapted American survey “with permission.” Methods: A cross-sectional survey of a selected 32 dietitians providing bariatric services completed a self-administered online questionnaire from 12 hospitals in Jeddah, Saudi Arabia. Results: All surveyed dietitians were females, mainly Saudi nationals (93.9%, n = 30), and accredited by the Saudi Commission for Health Specialties (93.8%, n = 30). Only 37.5% (n = 6) of the dietitians were specialized in bariatric surgery. Perioperative common practices of dietitians included a conduct of screening for nutrition risk before (44%, n = 14) and after surgery (62.5%, n = 20) and applied a nutrition management protocol that is mainly based on the application of nutrition care process (62.5%, n = 20). Dietitians (81%, n = 26) reported the importance of having standardized protocols for nutritional management of patients undoing bariatric surgery, where 69% (n = 22) confirmed the availability of pre-operative written protocols in hospitals and 75% (n = 24) confirmed the existence of post-operative protocols. Pre-operative practices included using approaches for weight loss before surgery, for example, very low and low-calorie diet. Dietitians (25%, n = 8) see two to ten patients per month. The sleeve gastrectomy procedure is the most often performed surgery. Conclusion: This is the first study to evaluate the perioperative nutrition care protocols and practices related to bariatric surgery in Saudi Arabia. Perioperative bariatric protocols are available, but some dietitians are not aware of their availability and contents. Researchers emphasize the importance of creating national protocols by the Saudi Credentials Body to standardize practices within the field.

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Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

Nutrients ◽

10.3390/nu13072316 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2316

Author(s):

Shelley Roberts ◽

Peter Collins ◽

Megan Rattray

Keyword(s):

Healthcare Professionals ◽

Monitoring And Evaluation ◽

Community Dwelling ◽

Community Context ◽

Care Process ◽

Community Settings ◽

Community Based ◽

Comprehensive Overview ◽

Nutrition Care ◽

Community Dwelling Older Adults

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

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Commentary: Quality nutrition care is integral to the Oncology Care Model

Supportive Care in Cancer ◽

10.1007/s00520-021-06436-x ◽

2021 ◽

Author(s):

Mary Beth Arensberg ◽

Beth Besecker ◽

Laura Weldishofer ◽

Susan Drawert

Keyword(s):

Best Practice ◽

Treatment Guidelines ◽

Nutrition Therapy ◽

Care Model ◽

Nutrition Care ◽

Ambulatory Oncology ◽

Oncology Care ◽

Improvement Programs ◽

And Performance ◽

Registered Dietitian Nutritionists

AbstractThe Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services (CMS) specialty model implemented in 2016, to provide higher quality, more highly coordinated oncology care at the same or lower costs. Under the OCM, oncology clinics enter into payment arrangements that include financial and performance accountability for patients receiving chemotherapy treatment. In addition, OCM clinics commit to providing enhanced services to Medicare beneficiaries, including care coordination, navigation, and following national treatment guidelines. Nutrition is a component of best-practice cancer care, yet it may not be addressed by OCM providers even though up to 80% of patients with cancer develop malnutrition and poor nutrition has a profound impact on cancer treatment and survivorship. Only about half of US ambulatory oncology settings screen for malnutrition, registered dietitian nutritionists (RDNs) are not routinely employed by oncology clinics, and the medical nutrition therapy they provide is often not reimbursed. Thus, adequate nutrition care in US oncology clinics remains a gap area. Some oncology clinics are addressing this gap through implementation of nutrition-focused quality improvement programs (QIPs) but many are not. What is needed is a change of perspective. This paper outlines how and why quality nutrition care is integral to the OCM and can benefit patient health and provider outcomes.

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Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study

Nutrients ◽

10.3390/nu13020314 ◽

2021 ◽

Vol 13 (2) ◽

pp. 314

Author(s):

Shelley Roberts ◽

Wendy Chaboyer ◽

Zane Hopper ◽

Andrea P. Marshall

Keyword(s):

Patient Satisfaction ◽

Patient Engagement ◽

Early Discharge ◽

Nutritional Risk ◽

Dietary Intakes ◽

Intervention Delivery ◽

Nutrition Care ◽

Tertiary Teaching ◽

Hospital Patients ◽

Tertiary Teaching Hospital

Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.

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Academy of Nutrition and Dietetics Nutrition Research Network: Validation of a Novel Nutrition Informatics Tool to Assess Agreement Between Documented Nutrition Care and Evidence-Based Recommendations

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2021.03.013 ◽

2021 ◽

Author(s):

Erin Lamers-Johnson ◽

Kathryn Kelley ◽

Damien M. Sánchez ◽

Kerri Lynn Knippen ◽

Micki Nadelson ◽

...

Keyword(s):

Research Network ◽

Evidence Based ◽

Nutrition Care ◽

Nutrition Research ◽

Nutrition And Dietetics

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Complying with Regulatory Requirements for Medical Directors in the Nutrition Care of Nursing Home Residents

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2009.12.019 ◽

2010 ◽

Vol 11 (3) ◽

pp. B7

Author(s):

Linda Handy ◽

Linda Handy

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Regulatory Requirements ◽

Nutrition Care ◽

Medical Directors

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Using logic models to enhance the methodological quality of primary health-care interventions: guidance from an intervention to promote nutrition care by general practitioners and practice nurses

Australian Journal of Primary Health ◽

10.1071/py16038 ◽

2017 ◽

Vol 23 (1) ◽

pp. 53 ◽

Cited By ~ 7

Author(s):

Lauren Ball ◽

Dianne Ball ◽

Michael Leveritt ◽

Sumantra Ray ◽

Clare Collins ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Care Setting ◽

Logic Model ◽

Practice Nurses ◽

Nutrition Care ◽

Health Care Interventions ◽

Primary Health ◽

Health Care Practitioners ◽

Logic Models

The methodological designs underpinning many primary health-care interventions are not rigorous. Logic models can be used to support intervention planning, implementation and evaluation in the primary health-care setting. Logic models provide a systematic and visual way of facilitating shared understanding of the rationale for the intervention, the planned activities, expected outcomes, evaluation strategy and required resources. This article provides guidance for primary health-care practitioners and researchers on the use of logic models for enhancing methodological rigour of interventions. The article outlines the recommended steps in developing a logic model using the ‘NutriCare’ intervention as an example. The ‘NutriCare’ intervention is based in the Australian primary health-care setting and promotes nutrition care by general practitioners and practice nurses. The recommended approach involves canvassing the views of all stakeholders who have valuable and informed opinions about the planned project. The following four targeted, iterative steps are recommended: (1) confirm situation, intervention aim and target population; (2) document expected outcomes and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Over a period of 2 months, three primary health-care researchers and one health-services consultant led the collaborative development of the ‘NutriCare’ logic model. Primary health-care practitioners and researchers are encouraged to develop a logic model when planning interventions to maximise the methodological rigour of studies, confirm that data required to answer the question are captured and ensure that the intervention meets the project goals.

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