An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

Nutritional practices in full‐day‐care pre‐schools

Background: Full‐day‐care pre‐schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre‐school child. The present study investigated nutritional practices in full‐day‐care pre‐schools in Dublin, Ireland, aiming to determine the nutritional support that pre‐school managers deem necessary, thereby facilitating the amelioration of existing pre‐school nutritional training and practices. Methods: A telephone questionnaire completed by pre‐school managers (n = 54) examined pre‐school dietary practices, food provision and the association between these and pre‐school size, nutritional training attendance, possession of the Food and Nutrition Guidelines for Pre‐school Services and having a healthy eating policy. Nutritional training needs were also investigated. Results: Twenty‐five pre‐schools provided all food for attending children; parents were sole providers in six. Thirty‐four pre‐schools had a written healthy eating policy. Attendance at nutritional training was reported by 40. Possession of the Guidelines (n = 40) did not consistently result in their use. Poor parental and staff involvement in policy and menu development was cited. Although the delayed introduction of iron‐containing foods and a feeding beaker in infants was clearly evident, inappropriate beverages and snacks were served to children aged 1–5 years in 43 and 37 pre‐schools, respectively. Training priorities cited by managers included parental education and the provision of information regarding menu planning and healthy food choices. Conclusions: Nutritional training should advocate whole staff familiarity with and use of current guidelines, in addition to encouraging nutritional policy development and enforcement. Parental education is warranted. Dietary education should focus specifically on appropriate weaning practices, healthy beverage and snack provision and menu planning.     

Hearts and Minds Project: A breastfeeding curriculum intervention to improve the education outcomes for nutrition and dietetics graduates

Aim: Dietitian nutritionists play an important role in supporting and promoting breastfeeding. Improving undergraduate training to create a competent and motivated workforce to deliver these outcomes has been recommended. This study evaluated a breastfeeding curriculum intervention designed to improve knowledge, attitudes and beliefs, and increase graduates' motivation to support breastfeeding into the future. Methods: Final‐year students studying nutrition and dietetics were surveyed at baseline in 2005 and post‐intervention in 2010. Questions related to student profile, breastfeeding knowledge, attitudes and beliefs, perceived professional role in breastfeeding support, intentions to support breastfeeding in the future and perceptions of the breastfeeding curriculum. Curriculum interventions were based on relevant evidence including recommendations from the baseline survey report, a gap analysis of existing curriculum, previous literature identifying key barriers to the support of breastfeeding by health professionals and learning and behaviour change theories and approaches. Results: General improvements in knowledge and attitudes and beliefs were found over the intervention period, although knowledge gaps remained on the risks associated with not breastfeeding for mothers and infants and when to recommend the cessation of breastfeeding. A significant increase was found in the percentage of respondents agreeing that their studies had engendered a strong interest in work involving breastfeeding. Significant improvements were also seen in student perceptions of the degree to which breastfeeding was addressed in the dietetic course. Conclusion: Curriculum interventions can effectively influence new graduates' future intention to support and promote breastfeeding if they address knowledge gaps, attitudes, beliefs and perceived social concerns about breastfeeding promotion.     

Incidence of nutritional risk and causes of inadequate nutritional care in hospitals

BACKGROUND AND AIMS: Many patients in hospitals are undernourished and nutritional care is inadequate in most hospitals. The aim of this investigation was to gain insight into how this situation could be improved. METHODS: Seven hundred and fifty randomly selected patients were screened at admission in three hospitals and surveyed during their entire hospitalization. Each time a patient was not treated according to a clearly defined nutritional standard, the nurse responsible for the patient was interviewed about possible reasons according to preformed questionnaires. RESULTS: The investigators found that 22% of the patients were nutritionally at-risk, and that only 25% of these patients received an adequate amount of energy and protein. The departments had only screened for nutritional problems in 60% of the cases. Only 47% of the patients, who the departments judged to be at-risk patients, had a nutrition plan worked out, and only about 30% of the at-risk patients were monitored by the departments by recording of dietary intake and/or body weight. The main causes for inadequate nutritional care were lack of instructions to deal with these problems, and lack of basic knowledge with respect to dietary requirements and practical aspects of the hospital's food provision. Patient-related aspects and the system of food provision also contributed, but only to a small degree. CONCLUSIONS: These findings form the basis of the strategy to improve nutritional care in these hospitals.     

复合式与单纯式营养干预效果的初步比较

目的　研究比较复合式与单纯式营养干预对社区三高人群的疾病控制效果差异 ,为社区慢病防治提供方法。方法　将基线调查筛查出的“三高”中老年居民 2 6 0人随机分配到复合式营养干预组、单纯式营养干预组和空白对照组。复合式营养干预组居民给予粗杂粮的膳食干预和营养教育 ,单纯式营养干预组居民给予营养教育。结果　三个月后 ,复合式和单纯式营养干预组的血脂、血压、血糖和IBM均比空白对照有不同程度的下降 ,复合式营养干预组下降幅度显著高于单纯式营养干预组。结论　复合式营养干预比单纯营养教育效果显著     

Inadequate oral intake in surgical patients: a rational indication for nutritional support

Seven days or more of inadequate oral intake (IOI) inevitably results in a deterioration in nutritional status. Despite this well-known fact, little information is available as to the frequency with which such periods of IOI occur in clinical practice. This study results from an audit of IOI in a gastroenterological unit over a 6-month period. The results demonstrate that 17% of patients sustained significant periods of IOI of 7 days or longer. This has important implications with regard to the provision of adjuvant nutritional support.     

A pilot audit of weight loss in upper gastrointestinal oncology outpatients

BACKGROUND: Patients with upper gastrointestinal malignancies have a high incidence of weight loss and malnutrition which has been associated with a reduced quality of life, performance status, increased risk of chemotherapy induced toxicity and decreased response to treatment. AIM: The aim of the pilot audit was to identify how many patients attending an upper gastrointestinal oncology outpatient clinic had lost weight or had nutritional problems. METHOD: A short questionnaire on present weight, weight loss and occurrence of symptoms was completed by 40 patients attending an upper gastrointestinal oncology outpatient clinic. RESULTS: Nutritional screening, including weight, was not routinely carried out on all patients. Only 40% of patients had been weighed at their clinic visit and 65% self-reported that they had lost weight. The frequency of symptoms in the weight loss group was higher than in the nonweight loss group and the incidence of nausea and dysphagia was significantly higher. Only 35% of patients had received dietary advice, but 68% of the remaining patients would have liked some. CONCLUSION: A significant number of patients reported weight loss and this was linked with a higher occurrence of symptoms influencing appetite and oral intake.     

Effect of nutrition supplement education on nutrition supplement knowledge among high school students from a low-income community

Research has shown that adolescents from low-income communities receive less educational resources and support and may possess insufficient knowledge of nutrition and sport supplements to make health conscious decisions. The purpose of this investigation was to determine the effectiveness of a nutrition supplement educational intervention in improving the nutrition supplement knowledge of adolescents from a low-income community. Thirty-nine high school students from a low-income community were separated into experimental (E) (n = 22) and control (C) (n = 17) groups. E received 5 nutrition lessons on various nutrition and sport supplement topics. C did not receive any nutrition education. E consisted of 5 freshmen, 5 sophomores, 6 juniors, and 6 seniors. The ethnic backgrounds of E were: 15 African-Americans, 3 Hispanic-Americans, and 4 others. There were 14 females and 8 males in E. C consisted of 9 freshmen, 1 sophomore, 4 juniors, and 3 seniors. The ethnic backgrounds of C were: 14 African-Americans, 1 Hispanic-American, and 2 others. There were 10 females and 7 males in C. Both groups were administered a validated nutrition and sport supplement questionnaire at baseline and post-intervention that consisted of 28 questions. Mean baseline knowledge scores for E and C were 5.73 ± 3.34 and 8.18 ± 3.82, respectively (p = 0.040). Post-intervention scores were: 14.45 ± 4.81 and 7.82 ± 4.79 for E and C, respectively (p = 0.0001). These results indicate that a short-term nutrition education program can significantly improve nutrition and sport supplement knowledge in high school students of low socioeconomic status.