Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients

Objective:  To determine the prevalence of malnutrition in a population of elderly hospitalised patients and to explore health professionals' perceptions and awareness of signs and risks of malnutrition and treatment options available.
Subjects and design:  One hundred elderly patients and 57 health professionals from medical wards of a tertiary teaching hospital. Quantitative and qualitative study design using a validated malnutrition assessment tool (Mini Nutritional Assessment) and researcher-designed questionnaire to assess health professionals' knowledge of nutrition risk factors.
Main outcome measures:  Mini Nutritional Assessment score, nutrition risk category and themes in health professionals' knowledge and awareness of malnutrition and its risk factors.
Results:  Thirty per cent of patients were identified as malnourished while 61% were at risk of malnutrition. Documentation by health professionals of two major risk factors for malnutrition—recent loss of weight and appetite—were poor with only 19% and 53% of patients with actual loss of weight or appetite, respectively, identified by staff and only 7% and 9% of these patients, respectively, referred for dietetic assessment. While health professionals' knowledge of important medical risk factors for malnutrition was good, their knowledge of malnutrition risk factors such as recent loss of weight and loss of appetite was poor. Medical staff focused on biochemical factors when assessing nutrition status, while nursing staff focused on skin integrity and turgor.
Conclusion:  Malnutrition in elderly hospitalised patients remains a significant problem with low rates of recognition and referral by medical and nursing staff. Considerable scope exists to develop training and education tools and to implement an appropriate nutrition screening policy to improve referral rates to dietitians.     

Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

Background  According to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians' expertise in the hospital units and, further, to assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition.
Methods  A questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common, as well as to 678 clinical dietitians working in Scandinavian hospitals.
Results  The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians.
Conclusions  The present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus on clinical nutrition.     

The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care

Background:  The Malnutrition Screening Tool (MST) is a valid nutrition screening tool in the acute hospital setting but has not been assessed in residential aged care facilities. The aim of this secondary analysis was to determine whether the MST could be a useful nutrition screening tool when compared with a full nutrition assessment by Subjective Global Assessment (SGA) in the residential aged care setting.
Methods:  Two hundred and eighty-five residents (29% male; mean age 84 ± 9 years) from eight residential aged care facilities in Australia participated in the study. A secondary analysis of data collected during a nutrition intervention study was conducted. The MST consists of two questions related to recent weight loss and appetite. Although the MST was not specifically applied, weight loss and appetite information was available and an estimated MST score (0–5) was calculated. Nutritional status was assessed by a research assistant trained in using the SGA.
Results:  Malnutrition prevalence was 42.8% (122 malnourished out of 285 residents). Compared to the SGA, the MST was an effective predictor of nutritional risk (sensitivity = 83.6%, specificity = 65.6%, positive predictive value = 0.65, negative predictive value = 0.84).
Conclusions:  The components of the MST have acceptable sensitivity and specificity, suggesting that it can play a valuable role in quickly identifying the risk of malnutrition in the residential aged care setting. Further prospective research using the MST tool against a broader array of objective and subjective nutritional parameters is required to confirm its validity as a screening tool in aged care settings.     

Audit of the completion of the nutrition screening tool on cardiac and cardiothoracic wards

Background: National Institute for Health and Clinical Excellence (NICE) guidelines (NICE, 2006) recommend screening all patients on admission to hospital, followed by weekly rescreening. In the Trust, all recruited nursing staff and healthcare assistants complete a mandatory induction programme, which includes training on the Trusts validated Nutrition Screening Tool (NST). The Trust guidelines require all NSTs to be completed within 48 h of a patient's hospital admission. Malnutrition is common in patients with severe heart failure (Veloso, 2005), with many patients suffering from anorexia and cardiac cachexia (Yamauti et al., 2006). Accurate completion of the NST is therefore essential in this population group to enable the development of nutrition support plans that address malnutrition and potentially improve patient outcomes. The aim of this audit was to evaluate whether cardiac and cardiothoracic wards are meeting both the NICE and Trust guidelines for accurate completion of the NST and appropriate referral to dietetic intervention. Methods: Audits were conducted on three cardiac and cardiothoracic wards over a 1‐week period in October 2010. The medical notes of all patients admitted to these wards were reviewed and the number of NSTs completed was recorded. The data collected included documentation of the patient's weight and height (measured/recalled) and whether body mass index (BMI) was < 18.5 kg m^?2, the presence of the NST score, correct completion of the NST, weekly screening of inpatients (where relevant) and referral to the dietetic service if the patient was at risk of malnutrition. Results: A total of 140 inpatients were included in the audit. Ninety‐seven patients (69%) had a NST score recorded; however, for five of these patients (5%), no information was given on how the NST score was calculated. Ten patients (10%) had a NST score ≥ 2, of which four (40%) were referred for dietetic input. Eight patients had a NST score of 4, indicating that they were at high risk of malnutrition, and four (50%) of these patients were referred for dietetic input. Weights and heights, either recalled or measured, were recorded in 75 (54%) and 63 (45%) of patients, respectively. BMI was checked and recorded for 27 patients (19%); however, for two patients (7%), the BMI was recorded without documenting either weight or height. Overall, 20 patients (14%) had a completed NST for all required information: weight, height, NST score and documenting whether BMI was < 18.5 kg m^?2. Fifty‐one patients were admitted to the cardiac wards for more than 1 week, of which only 12% (n = 6) had an accurate NST completed weekly. The sections of their NSTs most likely not to be completed were weight, height and documenting whether BMI was < 18.5 kg m^?2. Discussion: The results of this audit show that staff on the cardiac and cardiothoracic wards in this hospital were not compliant with either the Trust or NICE guidance for nutrition risk screening. Because of the low level of NST completion rates, it was not possible to provide a result for percentage malnutrition in cardiac patients. Patients at risk of malnutrition on these wards may not have been detected as a result of the poor NST completion rates. Of particular concern was the result that, although eight patients were screened as being at high risk of malnutrition, only half were referred for dietetic input. Conclusions: Despite ongoing training of all recruited nursing staff and healthcare assistants, there is a low level of completion of NSTs on cardiac and cardiothoracic wards. Future research should aim to identify the barriers to screening in this setting because our previous work has shown that training alone is insufficient to achieve improved NST completion rates. References: NICE (2006) Nutrition Support for Adults Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. http://www.nice.org.uk/nicemedia/live/10978/29981/29981.pdf (accessed on 22 January 2011). Veloso, L.G., de Oliveira, M.T. Jr, Munhoz, R.T., Morgado, P.C., Ramires, J.A. & Barretto, A.C. (2005) Nutritional repercussion in advanced heart failure and its value in prognostic assessment. Arq. Bras. Cardiol. 84 , 480–485. Yamauti, A.K., Ochiai, M.E., Bifulco, P.S., de Araújo, M.A., Alonso, R.R., Ribeiro, R.H. & Pereira‐Barretto, A.C. (2006) Subjective global assessment of nutritional status in cardiac patients. Arq. Bras. Cardiol. 87 , 772–777.     

A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

Increased frequency and accuracy of MUST screening after use of a nutrition screening round

Background: Surveys indicate that malnutrition remains common among hospital patients (Russell & Elia, 2010). It is recommended that all patients be screened on admission and weekly (NICE, 2006). The Malnutrition Universal Screening tool (MUST) is a sensitive and specific screening measure (Kyle et al., 2006). In Homerton Hospital, the nutrition screening round (NSR) ran alongside transition of paper‐based screening onto an electronic patient record system (EPR). This study aimed to assess the effectiveness of a dietitian‐led NSR as a method of training staff to use MUST. Methods: Malnutrition screening was audited on an elderly care ward and an adult rehabilitation unit. The number of MUST scores undertaken within 24 h of admission and the frequency of weekly screening were assessed. Data gathered included the numbers of patients with accurately measured height, weight, body mass index, weight loss and acute disease effect scores. A weekly NSR was then conducted on these two wards alongside consultant ward rounds, with the dietitian carrying out nutritional care and all staff gaining practical experience of MUST by assisting with screening of each patient. After 20 weeks, screening levels were re‐audited and, at 24 weeks nursing staff took back full responsibility for MUST screening. A final audit of screening levels took place 1 month after staff on the two designated wards had taken back responsibility for screening. Results: The initial audit indicated that, of 53 patients, 26 had a paper MUST proforma present. Of 23 patients who were on the wards for >7 days who had a MUST proforma, only one was screened each week as per NICE guidelines. The 20‐week mid‐intervention audit showed that the number of patients on the wards for ≥1 week with an accurate MUST screen recorded on EPR had increased to 100%. Increased detection of malnutrition led to prompt, effective nutrition support. The final audit at 28 weeks showed sustained screening levels, with all patients on the ward for ≥1 week being accurately screened for malnutrition by ward staff alone. Discussion: The NSR appeared to target factors identified as being behind low levels of screening, including a low awareness of screening policy and poor screening skills (Porter, et al., 2009).Confidence in carrying out MUST was increased by ‘hands‐on’ training in the immediate patient environment. Perceived barriers to screening cited in other research include pressures of workload (Hodge, 2008). The NSR demonstrated that screening was not as time consuming as assumed and that it could be fitted alongside other tasks. Previous studies have suggested training might be targeted toward all clinical staff (Wong & Gandy, 2008). The NSR project supports this finding, demonstrating that the involvement of all members of the multiprofessional team is strongly conducive to embedding MUST within clinical care and as part of weekly ward routine. Conclusions: A NSR is an effective way of providing practical training in nutritional screening. A NSR raises the ward level profile of screening, encourages it to become routine practice and is a feasible method of increasing frequency of screening in line with policy to enhance patient care. References: Hodge, A. (2008) An exploratory case study of cancer nurses’ understanding and use of nutritional screening in patients diagnosed with cancer. J. Hum. Nutr. Diet. 21 , 388–389. Kyle, U.G., Kossovsky, M.P., Karsegard, V.L. & Pichard, C. (2006) Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin. Nutr. 25 , 409–417. NICE (2006) Nutrition Support in Adults. Clinical Guideline 32. London: NICE. Porter, J., Raja, R., Cant, R. & Aroni, R. (2009) Exploring issues influencing the use of the Malnutrition Universal Screening Tool by nurses in two Australian hospitals. J. Hum. Nutr. Diet. 22 , 203–299. Russell, C. & Elia, M. (2010) Nutrition Screening Survey in the UK and Republic of Ireland in 2010. Redditch: British Association for Parenteral and Enteral Nutrition. Wong, S. & Gandy, J. (2008) An audit to evaluate the effect of staff training on the use of the Malnutrition Universal Screening Tool. J. Hum. Nutr. Diet. 21 , 405–406.     

Food advertisements containing 'scientific' and 'lay person' keywords: Responses from a sample of female Australian consumers

Aim:  To describe female consumer responses to food advertisements containing nutrition messages differentiated by use of 'scientific' and 'lay person' keywords.
Method:  'Lay person' and 'scientific' keywords were identified in advertisements from an audit of Australia's 30 top circulation magazines by people with or without formal scientific training in nutrition. Eight sample print advertisements were selected for consideration in focus group interviews. Four semistructured qualitative focus group interviews were conducted (women 25–63 years, n = 25 participants in total). Each group discussed four advertisements (two with 'lay person' and two with 'scientific' nutrition keywords). Thematic content analysis, including constant comparison and consensus, was driven by identifying types of responses and attributed meanings of keywords.
Results:  Participants' responses to the sample advertisements ranged from giving an immediate judgement, attributing meaning to keywords, responding to the keyword's novelty, describing the process of information analysis and addressing tangential issues such as photographic cues. The diversity in response occurred whether the advertisement contained 'scientific' or 'lay person' keywords and reflected the influence of multiple discourses on perceptions of the credibility and persuasiveness of nutrition messages
Conclusions:  Consumers' responses to keywords in advertisements are complex. Communications research that tests the message in its total context is needed to ensure the meaning of nutrition messages are being conveyed as is intended.     

Generational attitudes of rural mental health nurses

Objective:  To determine how attitudes of rural mental health nurses differ across generations.
Design:  Survey.
Setting:  Mental health services in rural New South Wales.
Participants:  Practising mental health nurses.
Main outcome measures:  Survey responses.
Results:  Survey response rate 44%. A total of 89 mental health nurses, clustered in inpatient units and community health centres, responded. Of these nurses, 4 were veterans, 52 baby boomers, 17 Generation X and 5 Generation Y.
Conclusions:  There are significant differences in how mental health nurses from different generations view their work, and in what is expected from managers. Managers need to modify traditional working styles, allowing greater flexibility of employment. They must also accept lower staff retention rates, and facilitate the development of younger staff.     

Establishing an innovative model of nutrition and dietetic care for a mental health service through collaboration with non-nutrition healthcare workers

Aim:  To describe the process of the development of the Web-based resources to extend nutrition care to mental health patients through existing non-nutrition mental healthcare professionals (case-managers).
Methods:  A formative approach was used to identify nutrition-related issues faced by both patients and staff through a synthesis of literature review, professional experience and clinical observations. Decision-making tools to assist case-managers in selecting resources were developed to guide case-managers' choice of effective evidence-based health education materials on the hospital intranet. Practical training was provided for case-managers during their orientation to the new website and the tools and resources it housed.
Results:  A Web-based nutrition site was created on the Royal Brisbane and Women's Hospital intranet. The website consisted of a Nutrition Referral Action Plan (a patient support triaging flowchart), a Nutrition Support Action Plan (action-based nutrition support tool to guide resource selection) and thirteen action-based nutrition education resources.
Conclusion:  By maximising established patient contact through existing health professionals, a Web-based approach to nutrition service delivery was an innovative method for delivering patient information. This collaborative action-based strategy has the potential to raise the nutrition profile in mental health and extend nutrition services to at-risk patients not previously receiving nutrition care.     

Delivering equitable care: comparing preventive services in Manitoba

OBJECTIVES: This study examined preventive care delivered in Manitoba during the 1990s by 3 different methods -childhood immunizations (by physicians and public health nurses under a government program), screening mammography (through a government program introduced in 1995), and cervical cancer screening (no program). METHODS: Longitudinal administrative data, an immunization monitoring system, and Canadian census databases were used. RESULTS: Cervical cancer screening rates remained static and showed strong socioeconomic differences; childhood immunization rates remained high with small socioeconomic gradients. The introduction of the Manitoba Breast Screening Program resulted in rising rates of screening and vanishing socioeconomic gradients. CONCLUSIONS: Manitoba government programs in childhood immunization and screening mammography actively helped the provision of preventive care. Organized programs that target population groups, recognize barriers to access, and facilitate self-evaluation are critical for equitable delivery.     

Valuing Experience Factors in the Provision of Chlamydia Screening: An Application to Women Attending the Family Planning Clinic

Objective:  To examine women's preferences for characteristics of chlamydia screening. Chlamydia trachomatis is the most common curable sexually transmitted disease. To design effective screening programs, it is important to fully capture the benefits of screening to patients. Thus, the value of experience factors must be considered alongside health outcomes.
Methods:  A self-complete discrete choice experiment questionnaire was administered to women attending a family planning clinic. Chlamydia screening was described by five characteristics: location of screening; type of screening test; cost of screening test; risk of developing pelvic inflammatory disease if chlamydia is untreated; and support provided when receiving results.
Results:  One hundred twenty-six women completed the questionnaire. Respondents valued characteristics of the care experience. Screening was valued at £15; less invasive screening tests increase willingness to pay by £7, and more invasive tests reduce willingness to pay by £3.50. The most preferred screening location was the family planning clinic, valued at £5. The support of a trained health-care professional when receiving results was valued at £4. Respondents under 25 years and those in a casual relationship were less likely to be screened.
Conclusions:  Women valued experience factors in the provision of chlamydia screening. To correctly value these screening programs and to predict uptake, cost-effectiveness studies should take such values into account. Failure to do this may result in incorrect policy recommendations.     

Cost-Effectiveness of a School-Based Emotional Health Screening Program

Background:  School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral.
Methods:  Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost.
Results:  Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%.
Conclusion:  Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.     

Management and perception of hospital undernutrition-a positive change among Danish doctors and nurses

BACKGROUND: Undernutrition in hospitals is a common problem associated with increased morbidity and mortality, prolonged convalescence and duration of hospital stay and increased health care costs. During recent years several initiatives have brought hospital undernutrition into focus and guidelines and standards have been published. In 1997, a questionnaire-based survey among Danish hospital doctors and nurses in selected departments concluded that clinical nutrition did not fulfil accepted standards. AIMS: We wished to determine if improvements had occurred in the intervening period. METHOD: Thus, in 2004 a similar questionnaire was sent to 4000 randomly selected Danish hospital doctors and nurses and responses were compared to those from 1997. The questionnaire dealt with attitudes and practice in the areas of nutritional screening, treatment plan, monitoring as well as with knowledge, education, tools and guidelines, organisation and possible barriers to implementation of nutritional screening and therapy. RESULTS: The overall response rate was 38%. We observed a marked improvement especially in screening procedures, calculation of energy intake in at-risk patients and local availability of guidelines. Many departments had appointed staff members with special interest and knowledge in clinical nutrition. CONCLUSION: Although significant positive changes had thus occurred, the main barriers against implementation of good nutrition care continued to be lack of knowledge, interest and responsibility, in combination with difficulties in making a nutrition plan. This will be the focus of future activities.     

Screening for intimate partner violence by health care providers. Barriers and interventions

INTRODUCTION: Routine screening for intimate partner violence (IPV) is endorsed by numerous health professional organizations. Screening rates in health care settings, however, remain low. In this article, we present a review of studies focusing on provider-specific barriers to screening for IPV and interventions designed to increase IPV screening in clinical settings. METHODS: A review of published studies containing original research with a primary focus on screening for IPV by health professionals was completed. RESULTS: Twelve studies identifying barriers to IPV screening as perceived by health care providers yielded similar lists; top provider-related barriers included lack of provider education regarding IPV, lack of time, and lack of effective interventions. Patient-related factors (e.g., patient nondisclosure, fear of offending the patient) were also frequently mentioned. Twelve additional studies evaluating interventions designed to increase IPV screening by providers revealed that interventions limited to education of providers had no significant effect on screening or identification rates. However, most interventions that incorporated strategies in addition to education (e.g., providing specific screening questions) were associated with significant increases in identification rates. CONCLUSION: Barriers to screening for IPV are documented to be similar among health care providers across diverse specialties and settings. Interventions designed to overcome these barriers and increase IPV-screening rates in health care settings are likely to be more effective if they include strategies in addition to provider education.     

Preliminary results of patient satisfaction with nutrition handouts versus dietetic consultation in oncology outpatients receiving chemotherapy

Aim:  To determine patient satisfaction with nutrition interventions in outpatients receiving chemotherapy identified as at nutritional risk.
Methods:  An observational, cross-sectional study was conducted at an Australian public hospital in 61 oncology outpatients receiving chemotherapy. A simple malnutrition screening tool was used to identify nutritional risk. Patients identified as moderate risk were triaged to receive nutrition handouts on increasing energy and protein intake. Those at high risk received nutrition counselling and support by a dietitian. Patient satisfaction was assessed using a modification of a valid and reliable satisfaction with nutrition services questionnaire.
Results:  Sixty-one patients entered the study and one-third (20/61) were at nutritional risk. Seven patients were at high risk, and received dietetic review while 13 patients were at moderate risk and received nutrition handouts. Patients identified as at nutritional risk (n = 20) were approached to complete the satisfaction with nutrition services questionnaire. Eighteen patients completed the questionnaire (n = 7: dietetic review; and n = 11: nutrition handout). Nutrition information/advice was rated as helpful (n = 15), met patient expectations (n = 16) and overall patient satisfaction was rated highly. Patients who had received a dietitian review recorded a clinically but not statistically higher overall satisfaction with nutrition services than those patients receiving the nutrition handout.
Conclusion:  The high patient satisfaction helps support nutrition intervention at the chemotherapy unit. A prospective trial is required to determine the benefits of this triage and nutrition intervention on nutrition-related outcomes.     

Nutritional support in acute stroke: the impact of evidence-based guidelines

BACKGROUND AND AIMS: Stroke patients experience multiple impairments which impair ability to eat and render them vulnerable to the deleterious sequelae of malnutrition. This study aimed to develop, implement and evaluate evidence-based guidelines for nutrition support following acute stroke using a multifaceted change management strategy. METHODS: Prospective quasi-experimental design. Documentation of two groups of 200 acute stroke patients admitted to medical and care of the elderly wards of an acute NHS Trust in South London was surveyed using a checklist before and after implementation of 24 guidelines for nutritional screening, assessment and support. Guidelines were based on systematic literature review and developed by consensus in a nurse-led multiprofessional group; implemented via a context-specific, multifaceted strategy including opinion leaders and educational programmes linked to audit and feedback. STAFF OUTCOMES: Compliance with guidelines by doctors, nurses, therapists. PATIENT OUTCOMES: Changes in Barthel Index scores and Body Mass Index in hospital, infective complications, length of stay, discharge destination. RESULTS: Statistically significant improvements in compliance with 15 guidelines occurred in the post-test group. Infective episodes showed a significant reduction in the post-test group but other patient outcomes were unaffected. CONCLUSIONS: Implementation of evidence-based guidelines for nutritional support following acute stroke using a multifaceted strategy was associated with improvements in documented practice and selected patient outcomes.     

General practitioner and paediatrician self-reported capacity for the diagnosis and management of childhood and adolescent overweight and obesity

Aim:  The purpose of the present study was to assess and document the self-reported capacity, knowledge, skill and confidence of Central Coast general practitioners and paediatricians in the identification and management of overweight and obesity in children and adolescents, to investigate the barriers they experience in this area of practice and to consider how the local public sector nutrition service may assist.
Methods:  Forty general practitioners and three paediatricians were interviewed using a semistructured purpose-designed questionnaire.
Results:  Most participating doctors perceived that public sector dietitians are not available to assist them in managing overweight and obese paediatric patients. Few (23%) doctors reported using published guidelines and most reported significant barriers limiting their capacity to identify and manage this patient group effectively. All doctors identified at least one way in which the public health system can better support doctors in this role.
Conclusions:  The findings suggest that many doctors may benefit from increased training and a health system that better remunerates them for the time investment needed to provide management consistent with best practice. Reorientation of local public sector nutrition services may also provide them with better support when managing overweight and obese paediatric clients. Future research should examine the actual practices of doctors and how public sector dietitians can best communicate and interact with them to facilitate effective management of these patients.     

New Jersey School Nurses' Perceptions of School-Based, Prenatal Nutrition Education

ABSTRACT: This study used formative evaluation to identify channels and barriers to providing ongoing dietary guidance to pregnant teens in New Jersey. In phase one, 14 health and social service professionals participated in a focus group or interview about nutrition services for pregnant teens. Participants identified school nurses as potential providers of early and continuous dietary counseling to pregnant teen-agers, but delineated barriers to establishment and effectiveness of school-based, prenatal nutrition education. In phase two, school nurses were surveyed to assess their interest in, and perceptions of barriers to, providing nutrition education to pregnant adolescents. Two-hundred fifty-three nurses (71%) returned completed questionnaires. Results indicated that a significant proportion perceived a need for, and were interested in providing, nutrition education to pregnant students. Results from this formative research are being used to guide development of a school-based nutrition education program for pregnant teen-agers in New Jersey.     

Australian normative data for the Occupational Therapy Adult Perceptual Screening Test

Objectives:  The purpose of this study was to examine variables impacting on the performance of healthy adults on the Occupational Therapy Adult Perceptual Screening Test (OT-APST), and present the Australian normative data for this standardised assessment tool.
Method:  The OT-APST was administered to a sample of healthy adults aged 16–97 ( n  = 356).
Results:  Neither gender nor highest level of education significantly impacted on OT-APST performance in the healthy normative group. Increasing age significantly correlated with reduced performance on all OT-APST subscales except for body scheme. Australian normative data for the OT-APST are presented in two age intervals: 16–74 years ( n  = 232) and 75–97 years ( n  = 124).
Conclusion:  Presentation of a large, age-stratified Australian normative data set including cut-off scores for intact/impaired perceptual performance for each of the OT-APST subscales will enable occupational therapists to make a norm-referenced interpretation of scores for individual clients when using this screening tool.