Hospital Food Research Articles

SP4.2.2 Recovery after Emergency Laparotomy – what do patients want?

Abstract Aim Recent focus on Emergency Laparotomy outcomes has improved mortality, but little attention has been given to recovery. The aim of this qualitative study was to explore recovery after EmLap. Method A focus group was established of ten EmLap patients. Inclusion criteria: EmLap<5 years ago, non-palliative. Patients were selected to provide balance of age, sex and pathology. Thematic qualitative analysis was performed by two researchers. Results Several key themes were highlighted; Lack of communication on diagnosis/expectations after surgery. Little continuity of care. Long delays in seeing doctors after surgery and no way to contact them and GPs unable to help. Financial consequences are significant, with no guidance. Took longer to recover than expected, difficult to explain to employer. Led to early retirement or change of hours/role. Hernias; Some patients aware of hernia risk but given conflicting advice, e.g avoid lifting and rest for 6 weeks, others told to exercise regularly. Difficult to access support garments. Diet – Conflicting advice on what they could/couldn't eat, especially fibre. Felt more by patients who had stoma or bowel resection. Poor quality food in hospital and lack of options for diet (e.g. vegan, coeliac). Poor mental health after surgery with anxiety, depression and loss of confidence all having large impact, especially on relationships and intimacy. Key issues lack of access to services and waiting times. Too ‘complex’ for primary care. Conclusions The impact of emergency surgery on patients is significant, particularly mental health and financial impact. Recommend standardised information (leaflets/website/signposting) and key support worker.

EP-43 Soup and sweet is not enough to eat: Postoperative nutritional intake is inadequate following open colorectal resection

Abstract Aims Adequate postoperative nutrition reduces complications and may modulate the metabolic stress response to surgery. In particular, protein intake may reduce loss of muscle mass and function thereby enhancing recovery to a normal functional level. This study aimed to assess the adequacy of nutritional intake in patients following an ERAS protocol after open colorectal resection. Methods Dietary intake on postoperative day (POD) 1 to 4 was recorded. Energy (Kcal) and protein (g) intake was calculated using information from the hospital's food supplier. Values were compared to the European Society of Clinical Nutrition (ESPEN) guidelines for perioperative patients (25Kcal/kg and 1.5g/kg of protein per day, based on ideal body weights). Results Eleven patients were recruited. Mean daily energy intake was 490.0Kcal (± 470.7), 505Kcal (± 251.8), 541.0Kcal (± 488.1) and 610.5Kcal (± 900.5) on POD 1–4 respectively. Mean daily protein intake was 13.9g (± 14.1), 14.9g (± 10.2), 15.0g (± 15.6) and 18.5g (± 25.6) on POD 1–4 respectively. Excluding patients who developed ileus (n=4), total energy and protein intakes over POD1–4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount respectively. In patients with ileus these values reduced to 12.8% (± 2.6) and 5.7% (± 0.9). Two thirds of meal choices were soup, jelly or ice cream. Conclusions Early postoperative nutrition after open colorectal resection in inadequate. Further strategies are required to counteract this. Examples may include protein fortification of popular postoperative meal choices and prehabilitation to improve patient's nutritional reserves.

'It's a constant changing environment, and we're just playing catch up': Hospital food services, food waste, and COVID-19.

AimsHospital food service operations have been affected by the COVID‐19 pandemic, particularly resulting in increased waste. The aim of this research was to explore the impact of the COVID‐19 pandemic on hospital food services, particularly on food waste and the completion of food waste audits.MethodsA qualitative interview research design was used. Semi‐structured interviews were completed and recorded via Zoom, focusing on the barriers and enablers towards the completion of hospital food waste audits. Twenty‐one participants were interviewed from 12 hospitals. No questions were related to the COVID‐19 pandemic and its impact on hospital food services, however this issue frequently emerged during interviews. Data were coded following inductive thematic analysis.ResultsFive themes were generated from the interviews related to COVID‐19 and hospital food services; impacts on practice, labour, change, technology and post‐pandemic expectations. Participants reported COVID‐19 negatively affected food service operations. Changes included increased food waste, contact restrictions, and labour shortages. Nonetheless, hospitals embraced the challenge and created new positions, trialled different food waste data collection methods, and utilised technology to support food service operations around COVID‐19 restrictions.ConclusionsDespite the impact COVID‐19 had on hospital food services, including their ability to audit food waste and increased food waste generation, the response from food services has demonstrated their adaptability to change. Sustainable healthcare, including the aggregate measuring and reduction of food waste in hospital food services, is an essential transition post‐pandemic, and may be facilitated through the operational changes forced by COVID‐19.

P036 Cultural Appropriateness and Foods Consumed by Clients Receiving a Food Box from a Children's Hospital Food Pharm Program

<h3>Background</h3> A Midwestern children's hospital in a metropolitan city provided healthy food boxes to families screened as food insecure from July 2021-February 2022. The food boxes provided sufficient food to feed a family of four for three days. However, as with much of emergency food, the cultural appropriateness of the food provided and the amount of food consumed by the receiving families is unknown. <h3>Objective</h3> Therefore, the purpose of this research study was to determine the cultural appropriateness of food provided and the amount of food consumed from the food box. <h3>Study Design, Setting, Participants</h3> This was a cross-sectional study. A total of 46 families who had received a food box from the children's hospital answered an interview-administered questionnaire over the telephone. A translation service was provided for participants who did not speak English. <h3>Measurable Outcomes/Analysis</h3> Perceived cultural appropriateness, amount consumed and most and least favorite foods were determined through closed-ended questions. Frequency descriptives were utilized to determine the food box perceptions and amount consumed. Chi-square tests were used to determine the correlation between participants who identified with a culture outside of the US and perception of cultural appropriateness of the food. <h3>Results</h3> At least 50% of participants indicated consuming >50% of every item provided except the shelf-stable milk (37%). The least favorite item was shelf-stable milk (25%) and the most favorite items were rice (29%), cereal (21%) and dried fruit (21%). Further, participants who identified with a culture outside of the US (n = 10) were significantly less likely to perceive canned mixed vegetables (<i>P <</i> 0.01) and applesauce (<i>P <</i> 0.02) as culturally appropriate but more likely to perceive shelf-stable milk (<i>P <</i> 0.49) compared to participants identifying only with the US culture (n = 36). <h3>Conclusions</h3> Examining emergency foods most consumed by the client population can inform foods provided and promote consumption while decreasing potential food waste. <h3>Funding</h3> None

Food consumption and plate waste study in a public hospital food service in Natal, RN, Brazil

Aiming to better understand the food waste and eating habits of diners, this study determined, by sex, food consumption and plate waste in the lunch meal served to employees at a public hospital in Natal, RN, Brazil, during one week. Men consumed 34% more than women did. The average consumption of the week by men and women was 469 g. Women wasted, on average, 9% of what they placed on their plates, or 39 g per day. Men wasted, on average, 5% of what they placed on their plates, discarding 34 grams of food per day. According to these results, women wasted 4% more than men did. The average PW% of the week was of 7.7% (37 g per capita per day). The food wasted during the 5 days of distribution would have been enough to serve lunch to a total of 122 diners. The data here provided are useful for several reasons, as this study may be used as reference to evaluate food waste more accurately in the food service, to elaborate educational material to create awareness among diners and food service professionals, and to estimate the financial impact of food waste on the budget. One of the highlights of this study is the provision of data on the consumption and plate waste (% and in grams) not only by the whole population studied, but discriminated considering women and men, which is not the most conventional way presented by studies.

Food consumption and plate waste study in a public hospital food service in Natal, RN, Brazil

Food consumption and plate waste study in a public hospital food service in Natal, RN, Brazil

Assessment of Food Safety Knowledge, Attitudes and Practices of Food Service Staff in Bangladeshi Hospitals: A Cross-Sectional Study.

Food safety knowledge, attitudes and practices among hospital food service staff are crucial in the prevention of foodborne disease outbreaks, as hospitalized patients are more vulnerable to potential hazards. This study, therefore, sought to assess the food safety knowledge, attitudes and practices of food service staff in Bangladeshi hospitals. A cross-sectional study was conducted among 191 food service staff from seven different hospitals in Dhaka and Chattogram from October 2021 to March 2022 using pretested questionnaires. Multiple linear regression was used to identify the factors associated with the food safety knowledge, attitudes and practices. The findings showed moderate knowledge but high levels of attitudes and practices of food safety among hospital food handlers. Food safety knowledge was significantly higher among males, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations. Moreover, participants from private hospitals and participants working in a hospital that had a food service supervisor and dietitian in charge of food service operations had more positive attitudes and better practices regarding food safety. Hospital management should consider these factors for enhancing food handlers’ knowledge and increase training and supervision on food safety practices to reduce foodborne diseases and outbreaks.

Food handlers' knowledge, attitude, and practices about safe and hygienic food in Egyptian government hospitals

Food handlers' knowledge, attitude, and practices about safe and hygienic food in Egyptian government hospitals

Analysis of Food Management Practices and Safe Provision in Unclassified Restaurants in Nairobi City County, Kenya

The aim of the research was to establish how food safety practices influence safe food provision by unclassified restaurants in Nairobi City County. The Particular goals of the study were to: assess the influence of food handling practices on safe food provision, observe the role of food hygiene training on safe food provision, determine the effect of food legislation compliance on safe food provision and establish the role of management in ensuring that safety standards are achieved on safe food provision by unclassified restaurants in Nairobi City County. Descriptive survey design was employed as the blue print to guide the study. The study population was 124 unclassified restaurants in Nairobi Central Business District. Questionnaires were used in data collection, an in-depth interview guide and observation checklist. Quantitative data were analyzed through means, standard deviation, inferential models and presented in form of tables and figures. The study established that food handling practices on safe food provision by unclassified restaurants was statistically significant (χ=8.988; p value of .003&lt;0.05), food hygiene training and safe food provision by unclassified restaurants have a significant association (χ= 5.094, p value of .019&lt;0.05, food legislation compliance and safe food provision by unclassified restaurants have a significant association as supported (χ=4.544; p value of .025&lt;0.05) while the role of management and safe food provision by unclassified restaurants have a significant association (χ=11.107, p value of .001&lt;0.05). This paper concludes that food handling practices, food hygiene training, food legislation compliance and role of management impacts the safe food provision by unclassified restaurants. The study recommends for the need to periodically train restaurant workers on proper food handling practices. There is need for restaurant management to provide workers with sufficient clean dress code. The restaurant management needs to organize periodic training programs in form of short workshops, seminars and conferences with key stakeholders in the hospitality sector and food safety authorities. Keywords: Food management practices, food handling practices, food hygiene training, food legislation compliance, safe provision, unclassified restaurants.

Synchrony of Choice of the Departments in Tourism and Hospitality with Gender Stereotyped Careers

The choice of jobs portraits the community’s mindset. However, the consistency of Balinese mindset to gender-stereotyped careers and the distribution of the students' genders in each department in Bali Hospitality and Tourism Institutes or higher educations have not been reported. The present study aimed at examining the proportions of the students' genders in each department in Bali Hospitality and Tourism Institutes or higher educations and the community mindset regarding the choice of jobs based on gender. 1,656 students of the three Tourism and hospitality institutes in Bali took part. Data were based on the entrance test and questionnaire (Google Form) analyzed with iterative analysis (Yin, 2010). Hospitality Management, Food and Beverage Service Management, Hospitality, Food Service Management, and Tourism Management and Hospitality Administration are the favorite departments. Two of the six departments, Hospitality Management and Food and Beverage Service Management are the two most favorite departments. On the contrary, four least favorite departments are Travel Business Management, Tourism Destination, Convention and Exhibition Management and Spa Management. All departments of the Bali Tourism and Hospitality institutes, females are more dominant. It shows that Balinese community are flexible and hold the same mindset regarding gender-stereotyped careers, such as Food and Beverage Service Management, Hospitality, and Food and Service Management.&#x0D; &#x0D;

Training on the preparation of internal audit instruments on the application of Good Manufacturing Practices (GMP) for class B catering services

Good Manufacturing Practices (GMP) is the most fundamental food safety system, and it is required in the catering business. This community service strives to educate personnel in class B catering services, particularly hospital food providers, how to construct internal audit instruments for the application of GMP catering services. The online session was attended by 59 people from 23 different institutions. Following the training, 66.1% said that conducting an internal audit of GMP implementation was simple. A total of 98.3% said they are prepared to conduct routine internal audits on a regular basis, albeit in stages. Aside from that, all participants reported satisfaction with the training's implementation, with 82.76 percent stating that they were extremely satisfied.

Combined environmental and educational intervention in hospital food service to increase patients attitude and intention about a healthy diet

Abstract Funding Acknowledgements Type of funding sources: None. Background The elimination of unhealthy risk behaviors such as unhealthy diet, smoking or physical inactivity can prevent at least 80% of cardiovascular disease.(1) Diet has been the number two in modifiable factors attributing to cardiovascular disease burden in the last thirty years.(2) In spite of this, adherence to dietary guidelines in The Netherlands is as low as 20-30%.(3) Clearly, more effective strategies towards healthier dietary behavior are needed.(1) According to the dual process theory, behavior can be influenced via the deliberate system and the intuitive system.(4) The food services on the cardiology ward were revised aiming to influence both systems in admitted patients to gear them towards healthier choices. Purpose To assess the impact of a combined environmental and rational intervention on patients’ attitude and intention towards a healthier diet. Methods A pre-post interventional study was conducted from June 2020 till November 2021 in patients admitted to the Cardiology ward. Patients’ attitude, self-efficacy and intention towards a healthy diet were evaluated through the validated Dietary Intention Evaluation Tool for In-hospitalized patients (DIETI). The intervention was aimed at intuitive and rational behavioral processes. The intuitive part consisted of posters, healthy standard options and a traffic light system on the menu. The rational part consisted of information about a healthy diet on the menu, emphasis on the importance of a healthy diet, a renewed website on lifestyle and an educational course on diet and nudging for nurses and food service employees. Also, at discharge, patients received two salt free spice mixes with healthy, easy and cheap recipes to prepare at home. Results A total of 512/853 (60%) complete responses were received. The intervention group reported to have learned significantly more during their admission than patients in the control group (4.58 vs. 4.80, p=0.009). However, our intervention does not influence patients’ attitude or intention regarding a healthy diet (p=0,41 and p=0,49 respectively). Conclusions A hospital admission of approximately 3 days is enough to make a significant impact on patients’ perceived learning. However, a combined environmental and educational intervention did not have an effect on patients’ attitude or intention regarding a healthy diet.

Accuracy of an Artificial Intelligence-Based Model for Estimating Leftover Liquid Food in Hospitals: Validation Study.

BackgroundAn accurate evaluation of the nutritional status of malnourished hospitalized patients at a higher risk of complications, such as frailty or disability, is crucial. Visual methods of estimating food intake are popular for evaluating the nutritional status in clinical environments. However, from the perspective of accurate measurement, such methods are unreliable.ObjectiveThe accuracy of estimating leftover liquid food in hospitals using an artificial intelligence (AI)–based model was compared to that of visual estimation.MethodsThe accuracy of the AI-based model (AI estimation) was compared to that of the visual estimation method for thin rice gruel as staple food and fermented milk and peach juice as side dishes. A total of 576 images of liquid food (432 images of thin rice gruel, 72 of fermented milk, and 72 of peach juice) were used. The mean absolute error, root mean squared error, and coefficient of determination (R2) were used as metrics for determining the accuracy of the evaluation process. Welch t test and the confusion matrix were used to examine the difference of mean absolute error between AI and visual estimation.ResultsThe mean absolute errors obtained through the AI estimation approach were 0.63 for fermented milk, 0.25 for peach juice, and 0.85 for the total. These were significantly smaller than those obtained using the visual estimation approach, which were 1.40 (P<.001) for fermented milk, 0.90 (P<.001) for peach juice, and 1.03 (P=.009) for the total. By contrast, the mean absolute error for thin rice gruel obtained using the AI estimation method (0.99) did not differ significantly from that obtained using visual estimation (0.99). The confusion matrix for thin rice gruel showed variation in the distribution of errors, indicating that the errors in the AI estimation were biased toward the case of many leftovers. The mean squared error for all liquid foods tended to be smaller for the AI estimation than for the visual estimation. Additionally, the coefficient of determination (R2) for fermented milk and peach juice tended to be larger for the AI estimation than for the visual estimation, and the R2 value for the total was equal in terms of accuracy between the AI and visual estimations.ConclusionsThe AI estimation approach achieved a smaller mean absolute error and root mean squared error and a larger coefficient of determination (R2) than the visual estimation approach for the side dishes. Additionally, the AI estimation approach achieved a smaller mean absolute error and root mean squared error compared to the visual estimation method, and the coefficient of determination (R2) was similar to that of the visual estimation method for the total. AI estimation measures liquid food intake in hospitals more precisely than visual estimation, but its accuracy in estimating staple food leftovers requires improvement.

Frequency of Hepatic Encephalopathy (HE) among Hepatitis Patients at Mardan Medical Complex, Mardan

Introduction: Hepatic encephalopathy (HE) represents severe neuropsychiatric condition of acute and chronic liver disease. Approximately 70% HE found in patients already suffering from liver cirrhosis. The aim of this study was to find the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease. Materials and Methods: This descriptive study was conducted in Mardan medical complex in four months duration. Data was collected from one hundred patients using non-probability sampling technique. All the data were analyzed through statistical software, JMP, 10.0 SAS, USA. Results: This study reports the frequency of HE among 100 hepatitis patients with mean age 55±9years. Out of these patients, 58% were males and 42% females. In our study, infection was the main precipitating factor found in most of the patients examined, followed by spontaneous bacterial peritonitis (20% patients), constipation (18% patients), GI bleeding (13% patients), and electrolyte imbalance such as hypokelmia (6% patients) and hypernatremia (3% patients). Conclusion: It is concluded that HE is more common in male patients than female. The risk of HE can be minimized by providing good hygienic conditions and germs free food in hospital. Keywords: Hepatic encephalopathy, Hepatitis, Cirrhosis, Chronic liver diseases

From liability to asset: A large health system’s approach to transforming hospital food

Historically, hospitals are infamous for poor food quality. Valuing food as a tenant of health and well-being, Northwell Health, New York’s largest healthcare system, is transforming its hospital food program to become an asset and market competition differentiator. By focusing on structure, workforce, procurement and process, Northwell has improved patient experience performance “Quality of Food” by 61 percentile rank points within three years with minimal impact on budgetary cost. Experience Framework This article is associated with the Environment & Hospitality lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure.

Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.

Formulation of the Menu of a General Hospital After Its Conversion to a "COVID Hospital": A Nutrient Analysis of 28-Day Menus.

AimThe aim of the present study was to modify the hospital menu to increase energy and protein provision in COVID-19 patients.MethodsAfter the conversion of our hospital to a COVID-19 hospital, eggs, and comfort foods such as vanilla pudding were added to the menu to boost energy and protein intake of patients. All meals of the standard menu of the hospital, i.e., breakfast, lunch, and dinner were recorded for 14 consecutive days during two periods: pre-COVID-19 and after being converted to a “COVID hospital.” The menus were analyzed with the use of the USDA database.ResultsThe total content of energy (1,873 ± 87 vs. 2,489 ± 137 Kcal), protein (97 ± 11 vs. 126.4 ± 18.7 g), fat (55 ± 9 vs. 74.1 ± 12.8 g), and carbohydrate (241.0 ± 16.0 vs. 323.0 ± 16.0 g) of the provided menus was increased in the COVID-19 period compared to the pre-COVID period. The leucine provision was also increased (4.8 ± 1.08 vs. 7.2 ± 1.3 g). Changes in protein and leucine were greater for breakfast (10 vs. 21 g protein and 0.8 vs. 1.7 g of leucine). The menu during COVID-29 provided more vitamin C (69.5 vs. 109.4 mg), thiamine (1.5 vs. 1.6 mg), riboflavin (2.1 vs. 2.6 mg), niacin (20.6 vs. 27.2 mg), pantothenic Acid (5.7 vs. 7.9 mg), vitamin B6 (2 vs. 2.6 mg), folate (274 vs. 334 μg), B12 (4.8 vs. 6.2 μg), choline (296 vs. 458 mg) as well as vitamins A (8,564 vs. 21,258 IU), D (3.9 vs. 4.7 μg), and K (59.3-111.5 μg). As far as micronutrients are concerned, the provisions of calcium (972 vs. 1375 mg), iron (10.2-12.8 mg), magnesium (236 vs. 294 mg), phosphorus (1,325 vs. 1,807 mg), copper (1.0 vs. 1.3 mg), manganese (2.1 vs. 2.4 mg) and selenium (148 vs. 183 μg) were increased during the COVID-19 period.ConclusionSimple menu changes and addition of comfort foods can substantially boost the nutrient content of a hospital diet, which in concert with provision of oral nutritional supplements could have an impact on patients’ nutritional status.

Availability of Healthy Food and Beverages in Hospital Outlets and Interventions in the UK and USA to Improve the Hospital Food Environment: A Systematic Narrative Literature Review.

The aims of this systematic review are to determine the availability of healthy food and beverages in hospitals and identify interventions that positively influence the hospital food environment, thereby improving the dietary intake of employees and visitors. Embase, Medline, APA PsycInfo, Scopus, Google Scholar and Google were used to identify publications. Publications relating to the wider hospital food environment in the UK and USA were considered eligible, while those regarding food available to in-patients were excluded. Eligible publications (n = 40) were explored using a narrative synthesis. Risk of bias and research quality were assessed using the Quality Criteria Checklist for Primary Research. Although limited by the heterogeneity of study designs, this review concludes that the overall quality of hospital food environments varies. Educational, labelling, financial and choice architecture interventions were shown to improve the hospital food environment and/or dietary intake of consumers. Implementing pre-existing initiatives improved food environments, but multi-component interventions had some undesirable effects, such as reduced fruit and vegetable intake.

Patient Experience and Satisfaction in Online Reviews of Obstetric Care: Observational Study.

BackgroundThe quality of care in labor and delivery is traditionally measured through the Hospital Consumer Assessment of Healthcare Providers and Systems but less is known about the experiences of care reported by patients and caregivers on online sites that are more easily accessed by the public.ObjectiveThe aim of this study was to generate insight into the labor and delivery experience using hospital reviews on Yelp.MethodsWe identified all Yelp reviews of US hospitals posted online from May 2005 to March 2017. We used a machine learning tool, latent Dirichlet allocation, to identify 100 topics or themes within these reviews and used Pearson r to identify statistically significant correlations between topics and high (5-star) and low (1-star) ratings.ResultsA total of 1569 hospitals listed in the American Hospital Association directory had at least one Yelp posting, contributing a total of 41,095 Yelp reviews. Among those hospitals, 919 (59%) had at least one Yelp rating for labor and delivery services (median of 9 reviews), contributing a total of 6523 labor and delivery reviews. Reviews concentrated among 5-star (n=2643, 41%) and 1-star reviews (n=1934, 30%). Themes strongly associated with favorable ratings included the following: top-notch care (r=0.45, P<.001), describing staff as comforting (r=0.52, P<.001), the delivery experience (r=0.46, P<.001), modern and clean facilities (r=0.44, P<.001), and hospital food (r=0.38, P<.001). Themes strongly correlated with 1-star labor and delivery reviews included complaints to management (r=0.30, P<.001), a lack of agency among patients (r=0.47, P<.001), and issues with discharging from the hospital (r=0.32, P<.001).ConclusionsOnline review content about labor and delivery can provide meaningful information about patient satisfaction and experiences. Narratives from these reviews that are not otherwise captured in traditional surveys can direct efforts to improve the experience of obstetrical care.

Fluid and Salt Balance and the Role of Nutrition in Heart Failure.

The main challenges in heart failure (HF) treatment are to manage patients with refractory acute decompensated HF and to stabilize the clinical status of a patient with chronic heart failure. Beyond the use of medications targeted in the inhibition of the neurohormonal system, the balance of salt and fluid plays an important role in the maintenance of clinical compensation in respect of renal function. In the case of heart failure, a debate of opinion exists on salt restriction. Restricted dietary sodium might lead to worse outcomes in heart failure patients due to the activation of the neurohormonal system and malnutrition. On the contrary, positive sodium balance is the primary driver of water retention and, ultimately, volume overload in acute HF. Some recent studies reported associations of decreased salt consumption with higher readmission rates and increased mortality. Thus, the usefulness of salt restriction in heart failure management remains debated. The use of individualized nutritional support, compared with standard hospital food, was effective in reducing these risks, particularly in the group of patients at high nutritional risk.