There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need ...to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Many patients are admitted to hospital and are already malnourished. Gaps in practice have identified that care processes for these patients can be improved. Hospital staff, including management, ...needs to work towards optimizing nutrition care in hospitals to improve the prevention, detection and treatment of malnutrition. The objective of this study was to understand how staff members perceived and described the necessary ingredients to support change efforts required to improve nutrition care in their hospital.
A qualitative study was conducted using purposive sampling techniques to recruit participants for focus groups (FG) (n = 11) and key informant interviews (n = 40) with a variety of hospital staff and management. Discussions based on a semi-structured schedule were conducted at five diverse hospitals from four provinces in Canada as part of the More-2-Eat implementation project. One researcher conducted 2-day site visits over a two-month period to complete all interviews and FGs. Interviews were transcribed verbatim while key points and quotes were taken from FGs. Transcripts were coded line-by-line with initial thematic analysis completed by the primary author. Other authors (n = 3) confirmed the themes by reviewing a subset of transcripts and the draft themes. Themes were then refined and further detailed. Member checking of site summaries was completed with site champions.
Participants (n = 133) included nurses, physicians, food service workers, dietitians, and hospital management, among others. Discussion regarding ways to improve nutrition care in each specific site facilitated the thought process during FG and interviews. Five main themes were identified: building a reason to change; involving relevant people in the change process; embedding change into current practice; accounting for climate; and building strong relationships within the hospital team.
Hospital staff need a reason to change their nutrition care practices and a significant change driver is perceived and experienced benefit to the patient. Participants described key ingredients to support successful change and specifically engaging the interdisciplinary team to effect sustainable improvements in nutrition care.
Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304 , June 7, 2016.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Successful improvements in health care practice need to be sustained and spread to have maximum benefit. The rationale for embedding sustainability from the beginning of implementation is well ...recognized; however, strategies to sustain and spread successful initiatives are less clearly described. The aim of this study is to identify strategies used by hospital staff and management to sustain and spread successful nutrition care improvements in Canadian hospitals.
The More-2-Eat project used participatory action research to improve nutrition care practices. Five hospital units in four Canadian provinces had one year to improve the detection, treatment, and monitoring of malnourished patients. Each hospital had a champion and interdisciplinary site implementation team to drive changes. After the year (2016) of implementing new practices, site visits were completed at each hospital to conduct key informant interviews (n = 45), small group discussions (4 groups; n = 10), and focus groups (FG) (11 FG; n = 71) (total n = 126) with staff and management to identify enablers and barriers to implementing and sustaining the initiative. A year after project completion (early 2018) another round of interviews (n = 12) were conducted to further understand sustaining and spreading the initiative to other units or hospitals. Verbatim transcription was completed for interviews. Thematic analysis of interview transcripts, FG notes, and context memos was completed.
After implementation, sites described a culture change with respect to nutrition care, where new activities were viewed as the expected norm and best practice. Strategies to sustain changes included: maintaining the new routine; building intrinsic motivation; continuing to collect and report data; and engaging new staff and management. Strategies to spread included: being responsive to opportunities; considering local context and readiness; and making it easy to spread. Strategies that supported both sustaining and spreading included: being and staying visible; and maintaining roles and supporting new champions.
The More-2-Eat project led to a culture of nutrition care that encouraged lasting positive impact on patient care. Strategies to spread and sustain these improvements are summarized in the Sustain and Spread Framework, which has potential for use in other settings and implementation initiatives.
Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304 , June 7, 2016.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Integrated knowledge translation (IKT) and community-based participatory research (CBPR) are recognized as effective approaches when Indigenous and non-Indigenous partners work together to focus on a ...common goal. The "Learning Circles: Local Healthy Food to School" (LC:LHF2S) study supported the development and implementation of Learning Circles (LC) in 4 Canadian Indigenous communities with the goal of improving local, community-based healthy food systems. Critical to the research process were annual gatherings (AG) where diverse stakeholders (researchers, Indigenous community members, and partners) visited each community to share knowledge, experiences, and provide support in the research process. Using a qualitative, descriptive method, this paper explores how the AG supported IKT across partners. Yearly interviews involving 19 total participants (with some participating multiple times across the 4 gatherings) elicited their AG experiences in supporting local LC:LHF2S. Three themes with multiple sub-themes were identified: (a) setting the stage for IKT (importance of in-person gatherings for building relationships across partners, learning from each other), (b) enabling meaningful engagement (aligning research with Indigenous values, addressing tensions and building trust over time, ensuring flexibility, and Indigenous involvement and leadership), and (c) supporting food system action at the local level (building local community engagement and understanding, and integrating support for implementation and scale-up of LC). This paper provides useful and practical examples of the principles of Indigenous-engaged IKT and CBPR in action in healthy, local, and traditional food initiatives. AG are a valuable IKT strategy to contribute to positive, transformative change and ethical research practice within Indigenous communities. Key words: knowledge translation, community-based participatory research, Indigenous, health promotion, food systems, Learning Circles L'application integree des connaissances (<< IKT >>) et la recherche participative communautaire (<< CBPR >>) sont reconnues comme des approches efficaces lorsque des partenaires autochtones et non autochtones travaillent ensemble en se concentrant sur un objectif commun. L'etude << Learning Circles: Local Healthy Food to School >> (<< LC:LHF2S >>) a soutenu le developpement et la mise en oeuvre de cercles d'apprentissage (<< LC >>) dans quatre communautes autochtones canadiennes dans le but d'ameliorer les systemes locaux et communautaires d'alimentation saine. Les rassemblements annuels (<< AG >>) oU divers intervenants (chercheurs, membres des communautes autochtones et partenaires) ont visite chaque communaute pour partager leurs connaissances, leurs experiences etaient essentiels au processus de recherche. Au moyen d'une methode qualitative et descriptive, cet article explore la maniere dont l'AG a soutenu l'IKT parmi les partenaires. Des entretiens annuels impliquant 19 participants au total (certains participant plusieurs fois au cours des quatre rassemblements) ont renforce leurs experiences d'AG pour le soutien du LC: LHF2S local. Trois themes avec plusieurs sous-themes ont ete identifies : (a) preparer le terrain pour l'IKT (importance des rencontres en personne pour etablir des relations entre les partenaires, apprendre les uns des autres), (b) permettre un engagement significatif (aligner la recherche sur les valeurs autochtones, resoudre les tensions et renforcer la confiance au fil du temps, assurer la flexibilite et la participation et le leadership des Autochtones) et (c) soutenir l'action du systeme alimentaire au niveau local (renforcer l'engagement et la comprehension de la communaute locale et integrer le soutien a la mise en oeuvre et a l'intensification du LC). Ce document fournit des exemples utiles et pratiques des principes de l'IKT et de la CBPR impliquant les Autochtones en action dans des initiatives alimentaires saines, locales et traditionnelles. L'AG est une strategie d'IKT precieuse pour contribuer a un changement positif et transformateur et a une pratique de recherche ethique au sein des communautes autochtones. Traduit par la Redaction Mots-cles : application des connaissances, recherche participative communautaire, autochtone, promotion de la sante, systemes alimentaires, cercles d'apprentissage
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•The pandemic amplified inequities, brought both challenges and unexpected benefits.•Online engagement that is safe and flexible shows promise for diverse populations.•Project adaptation stages and ...processes may be relevant beyond pandemic times.•Practice guidance from study findings is available in a supplementary Hub tool.•Experiential evidence using storytelling methods provides novel and useful insights.
The Government of Canada's Mental Health Promotion Innovation Fund (MHP-IF) is a platform for learning across diverse projects, facilitated by a Knowledge Development and Exchange Hub. MHP-IF projects were getting underway before the COVID-19 pandemic escalated in 2020 and dramatically shifted their circumstances and activities. Using storytelling methods, this study explored 20 project experiences during the first year of the pandemic, including how and why assumptions, plans, and activities were adapted; early signals about what was working well or not; and how adaptations influenced equity, access, and cultural safety. Project teams generally navigated through four stages: pausing, re-thinking, adapting, and settling into adjustments. Within and across these stages, projects addressed similar processes, including meeting fundamental needs of participants and project teams, managing unanticipated benefits, and engaging with online formats. All projects experienced the pandemic's influence of amplifying both inequities and public and political attention on mental health. This study provides experiential evidence from diverse settings and populations in Canada about pandemic adaptations. The multi-project model and storytelling methods can usefully contribute to additional research, including ways to address inequities and promote cultural safety.
eaTracker
is Dietitians of Canada's online nutrition/activity self-monitoring tool accessible via website and mobile app. The purpose of this research was to evaluate the eaTracker
mobile app based ...on user perspectives.
One-on-one semi-structured interviews were conducted with adult eaTracker
mobile app users who had used the app for ≥ 1 week within the past 90 days. Participants (
= 26; 89% female, 73% 18⁻50 years) were recruited via email. Interview transcripts were coded using first level coding and pattern coding, where first level codes were grouped according to common themes.
Participants mentioned several positive aspects of the mobile app which included: (a) Dashboard displays; (b) backed by dietitians; (c) convenience and ease of use; (d) portion size entry; (e) inclusion of food and physical activity recording; and (f) ability to access more comprehensive information via the eaTracker
website. Challenges with the mobile app included: (a) Search feature; (b) limited food database; (c) differences in mobile app versus website; and (d) inability to customize dashboard displayed information. Suggestions were provided to enhance the app.
This evaluation provides useful information to improve the eaTracker
mobile app and also for those looking to develop apps to facilitate positive nutrition/physical activity behavior change.
BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; ...however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration number NCT02800304, NCT03391752.
Canadian provincial policies, like Ontario's School Food and Beverage Policy (P/PM 150), increasingly mandate standards for food and beverages offered for sale at school. Given concerns regarding ...students leaving school to purchase less healthy foods, we examined student behaviours and competitive food retail around schools in a large urban region of Southern Ontario.
Using a geographic information system (GIS), we enumerated food outlets (convenience stores, fast-food restaurants, full-service restaurants) within 500, 1000 and 1500 m of all 389 regional schools spanning years of policy implementation. Consenting grade 6-10 students within 31 randomly selected schools completed a web-based 24-h diet recall (WEB-Q) and questionnaire.
Food outlet numbers increased over time (
< 0.01); post-policy, within 1000 m, they averaged 27.31 outlets, with a maximum of 65 fast-food restaurants around one school. Of WEB-Q respondents (
= 2075, mean age = 13.4 ± 1.6 years), those who ate lunch at a restaurant/take-out (
= 84, 4%) consumed significantly more energy (978 vs. 760 kcal), sodium (1556 vs. 1173 mg), and sugar (44.3 vs. 40.1 g). Of elementary and secondary school respondents, 22.1% and 52.4% reported ever eating at fast food outlets during school days.
Students have easy access to food retail in school neighbourhoods. The higher energy, sodium and sugar of these options present a health risk.
As part of a larger evaluation of school nutrition programmes (SNP), the present study examined programme coordinators' perceptions of strengths, weaknesses, opportunities and threats (SWOT) ...regarding their SNP and public health professionals' support.
Qualitative interviews were conducted with twenty-two of eighty-one programme coordinators who had completed a programme evaluation survey. Interviews followed a SWOT framework to evaluate programmes and assessed coordinators' perceptions regarding current and future partnerships with public health professionals.
The study was conducted in a large, urban region within Ontario.
The twenty-two coordinators who participated represented a cross-section of elementary, secondary, Public and Catholic schools.
SNP varied enormously in foods/services offered, how they offered them and perceived needs. Major strengths included universality, the ability to reach needy students and the provision of social opportunities. Major weaknesses included challenges in forming funding partnerships, lack of volunteers, scheduling and timing issues, and coordinator workload. Common threats to effective SNP delivery included lack of sustainable funding, complexity in tracking programme use and food distribution, unreliable help from school staff, and conflicts with school administration. Opportunities for increased public health professionals' assistance included menu planning, nutrition education, expansion of programme food offerings, and help identifying community partners and sustainable funding.
The present research identified opportunities for improving SNP and strategies for building on strengths. Since programmes were so diverse, tailored strategies are needed. Public health professionals can play a major role through supporting menu planning, food safety training, access to healthy foods, curriculum planning and by building community partnerships.
Malnutrition is common in hospitalized patients and is associated with increased mortality, length of stay, and risk of re-admission. The consensus based Integrated Nutrition Pathway for Acute Care ...(INPAC) was developed and validated to enhance patients' nutrition care and improve clinical outcomes. As part of the More-2-Eat project (M2E), five hospitals implemented INPAC activities (e.g. screening) in a single medical unit. The purpose of this paper is to demonstrate the care gaps with respect to INPAC activities on these five units prior to implementation. Results were used as part of a needs assessment on each unit, demonstrating where nutrition care could be improved and tailoring of implementation was required.
Cross-sectional data was collected by site research associates (RAs) using a standardized audit form once per week for 4 weeks. The audit contents were based on the INPAC algorithm. All medical charts of patients on the study unit on the day of the audit were reviewed to track routine nutrition care activities (e.g. screening). Data was descriptively displayed with REDCap™ and analyzed using R Studio software.
Less than half of patients (249/700, 36%) were screened for malnutrition at admission. Of those screened, 36% (89/246) were at risk for malnutrition yet 36% (32/89) of these patients did not receive a dietitian assessment. Also, 21% (33/157) of patients who were not screened at risk were assessed. At least one barrier to food intake was noted in 85% of patient medical charts, with pain, constipation, nausea or vomiting being the most common. Many of these barriers were addressed through INPAC standard nutrition care strategies that removed the barrier (e.g. 41% were provided medication for nausea). Advanced nutrition care strategies to improve intake were less frequently recorded (39% of patients).
These results highlight the current state of nutrition care and areas for improvement regarding INPAC activities, including nutrition screening, assessment, and standard and advanced nutrition care strategies to promote food intake. The results also provided baseline data to support buy-in for INPAC implementation in each M2E study unit.
Retrospectively registered ClinTrials.gov Identifier: NCT02800304, June 7, 2016.
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