Foodservice Systems Research Articles

Personalization in mitigating food waste and costs in hospitalization

Organization of food services within hospitals has been identified as a determinant of hospitalized patients' nutritional intake and associated food waste. Whereas hospital food service systems in the Netherlands traditionally consist of 3 fixed mealtimes each day, we recently implemented a new 3-channel concept that provides patients the opportunity to order extra meals or snacks in-between their 3 main mealtimes or even have dinner with their visitors in a bistro located on their ward. This study investigates the impact of transitioning from a traditional paper-based to a patient-centered, digital hospital food service system on food waste production patterns and its associated financial implications. Plate waste (served but uneaten food) measurements were performed at baseline for all served meals during a one-week period within the traditional system and follow-up measurements were conducted annually after implementation of the new system during 3 consecutive years. Measurements were conducted at two hospital floors, each comprising four wards. Average grams of plate waste per served meal, daily meal frequency per patient and the associated production and disposal costs of the collected waste were calculated and compared between the two systems. A total of 4361 meals served within the traditional system were compared with 7815 meals served within the new digital system. Meal frequency increased from an average of 2.5 meals per patient per day in the old system to an average varying between 3 and 3.3 meals per patient per day in the consecutive years. Within the traditional system, average plate waste was 81grams per served meal, whilst it ranged between 33 and 49grams per served meal during the following years, with the 3-channel concept in place (p<0.001, p=0.010). Dinner demonstrated the largest reduction in plate waste at all measurement points. Following this reduction of plate waste, estimated associated costs of plate waste production and disposal decreased in a similar pattern. Transitioning from a traditional, paper based to a patient-centered and digital hospital catering system results in significantly higher daily meal frequency and less food waste per served meal.

The Global Research Trends on Food Waste At Healthcare Setting: A Bibliometric Analysis Using Scopus Database

The issue of food waste has garnered much attention globally due to its adverse impacts on the economy, food security, natural resources, the environment, and human health. Despite this, the academic literature lacks systematic, historical, and synthesising investigations on healthcare food waste. This bibliometrics analysis study aims to summarise the growing trends of food waste publications and highlight common and potential research topics of food waste in healthcare settings. The Scopus database analysed 193 journal articles published between 1952 and 2022. We identified several common and potential research topics for future research in the area, including food waste and malnutrition, related intervention strategies, the impact of healthcare food service systems on food waste, and their economic and environmental impact. Healthcare food waste research in developing nations is still limited. Thus, it is recommended that policymakers support its development as one of the steps to encounter food waste.

A study on toxin genes and cytotoxicity levels of Bacillus cereus in various ready-to-eat foods and pastry products in Turkey

Bacillus cereus is a spore-forming and toxin-producing gram-positive bacteria widely isolated from soils, meat, milk, and vegetables. It is recognized as one of the pathogenic bacteria that can lead to food poisoning and food spoilage in food service systems due to its ease of contamination of foods and lack of guarantee of elimination by pasteurization and sanitation practices. B. cereus causes two types of diseases mainly characterized by diarrhea and vomiting type syndrome with the toxins it produces. Toxins produced by B. cereus are mainly heat-stable emetic toxin and three different heat-labile enterotoxins. Foodborne illnesses of the diarrheal type are caused by the single protein toxin; cytotoxin K (CytK), and both tripartite toxins; hemolysin BL (Hbl), and the non-hemolytic enterotoxin (Nhe), whereas the emetic type, is caused by an emetic toxin cereulide. In this study, 225 ready-to-eat foods and pastry products were analyzed for B. cereus, its toxin profiles, and cytotoxicity effects. Multiplex PCR is used to identify the presence of the Hbl, CytK, and emetic toxin encoding genes. Component-specific antibody-based ELISA tests were utilized to determine the Hbl-L2 and NheB components. Cytotoxic activity of the B. cereus isolates on Vero cells was also identified. In total, B. cereus was detected in 37 out of 225 (16.4%) food samples. From the positive 37 B. cereus isolates, the ces gene was not identified, whereas 91.9% (34) Nhe, 56.8% (21) Hbl, and 8.1% (3) CytK encoding genes revealed positive results on PCR analysis. PCR results were also compatible with ELISA and Cytotoxicity tests. In a nutshell, 16.4% prevalence of B. cereus in foods is insufficient, and the presence or absence of toxin genes may not yield reliable results. It is critical to detect pathogenic B. cereus toxin gene profiles as well as toxin production ability at the same time. This study presents for the first time, data from a cell culture cytotoxicity test using specific monoclonal antibody-based sandwich ELISA and multiplex PCR for ready-to-eat foods and pastry products in Turkey

Perceptions of the Impact of COVID-19 Countermeasures on Safe Foodservice Provision at International Sporting Competitions: A Qualitative Study

Over the past 2 years, the SARS-CoV-2 (COVID-19) pandemic has had a pronounced impact on the foodservice sector, including compliance to new food provision guidelines. International sporting events’ over-crowded communal eating areas are considered to be high-risk areas for contracting infectious disease. The purpose of this study was to explore the perceptions, level of preparedness and perceived challenges of key stakeholders when providing food at major athletic competition events during a global pandemic. A qualitative methodology was employed using semi-structure interviews and data was analyzed using interpretive phenomenology. Inductive thematic analysis identified six major themes of COVID-19′s impact on foodservice systems. Adapting foodservice models to pandemic planning is pre-determined and dictated by settings and environments. There were common heightened concerns over sustainability practices, increase in waste management, costs and negative impact on social dining experience, which were all perceived to be impacted by the changes relevant to COVID-19. There was a renewed attention to improving food safety and quality control measures. The outcomes of this study suggest that International organizing committees of major competitions must now be tasked with updated guidelines, including supporting adequate budgets and communication, if stakeholders are to adapt their operations to control the spread of viruses, such as COVID-19, within all foodservice operations at major competitions. Attention should be directed to determine whether food provision changes continue to be recommended and how this will impact foodservice delivery, sustainability and the social dining experience at future sporting events.

Foodservice systems and mealtime models in rehabilitation: Scoping review.

To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting. A scoping review. PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022. The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment. Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n=9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes. This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes. No patient or public contribution was necessary for this review.

A Review of Cooking of Potatoes (Solanum tuberosum L.) Served in Large-Scale Food-Service Systems, Including Industrial Pre-Treatments

Potatoes (Solanum tuberosum L.) often constitute a meal’s main carbohydrate source. When consumed outside the home, dishes are often prepared in large-scale food service systems, like school canteens and hospitals. To manage the logistics of serving the required quantities of potatoes, raw tubers must be prepared by washing, industrial peeling, preservative actions, and packaging to stand transportation and storage before cooking. There are several steps of pre-treatment, packaging, transportation, and cooking techniques that differ from traditional preparation at home, and each of these steps— or more likely a combination of several steps— might contribute to reduced quality in terms of enzymatic discoloration, microbiological failure, and subsurface hardening. In this review, the effect of each of these steps on the potato tuber; from industrial peeling to steam-cooking in the large-scale food service system, has been studied to understand where the most significant quality changes occur, and to understand the combined impact of different actions.

Nutrition and diabetes self-management in aged care: Exploring community-dwelling older adults' expectations.

To explore the diabetes self-management expectations of older adults with diabetes, not yet accessing residential aged care services. Admission to residential aged care (RAC) can create many interruptions to usual food choices and diabetes self-management, and we know little about the concerns of the emerging ageing population. This is a qualitative study employing focus groups and inductive thematic analysis involving 18 older adults with diabetes between the ages of 60 and 88, living in their own homes within an Australian city. Focus groups were recruited on a sequential basis and progressively analysed using an inductive process until data saturation was reached. Focus groups were digitally recorded and transcribed verbatim for thematic analysis. Three key themes were generated: autonomy, individualised dietary management and the food service system. Older adults speculated that they would want a collaborative approach to maintain their health in ageing and to self-manage their diabetes while feasible. Participants wanted autonomy over food choices, flexible meal timings and quality meals. There was a significant anxiety that aged care staff and existing food service systems in RAC could not support these preferences. Community-dwelling older adults with diabetes would highly value aged care services that facilitated autonomy, individualised nutrition support and flexibility, but feared this will not be feasible. The introduction of new diabetes and RAC guidelines may require an implementation plan to include the full food service system, from staff education to meal preparation, ordering and service.

Evaluation of the menus of different food service systems during Covid-19 pandemic in Turkey

Rationale: The COVID-19 pandemic has affected the services of food service systems due to the restrictions. Within the scope of measures for preventing the transmission, take away-lunch box menus were served instead of table (self) service of normal menus in food service systems. This study aims to evaluate the different types of menus served by three different institutions during the COVID-19 pandemic in Turkey.

Assessment of Food Services Pre-requisite Program in a Tertiary Hospital in Egypt

Abstract Background Hospital food service systems are one of the most complicated processes where safety in this sector is considered high priority issue due to high susceptibility of hospital population. Objectives Our objectives were to identify the pre-requisite program components and the degree of compliance with these components in Ain Shams University Specialized Hospital. Methods A team was formed, identification of the prerequisite program components was carried out and a check list for determining the compliance with the identified components was used. Results From our study it was found that there is a severe lack in the prerequisite program items. Only 25% of the items were achieved, and the implementation of the prerequisite items ratio was 59.4% with severe lack of temperature control in the different stages of the food flow. Conclusions The present study showed that the necessary founding element of any food safety program, comprising the policies, operating procedures and similar organizing documents which was deficient in the studied hospital. Similarly, implementation of the basic required sanitation aspects in food handling was almost half applied. Reconsideration of basic underlying system for food services is mandated in our hospital.

Canadian Hospital Food Service Practices to Prevent Malnutrition.

Purpose: The study aimed to determine current practice, barriers, and enablers of foodservices in Canadian hospitals relative to guiding principles for best practice to prevent malnutrition.Methods: Foodservice managers completed a 55-item cross-sectional, online survey (closed- and open-ended questions).Results: Survey responses (n = 286) were from diverse hospitals in all Canadian regions; 56% acute care; 13% had foodservices contracted out; and 60% had a reporting structure combined with clinical nutrition. Predominantly, foodservice systems were 43% in-house versus 41% pre-prepared, 46% cook-serve food production, 64% meals assembled centrally (on-site), and 40% non-selective menus with limited opportunities for patient choice in advance or at meals. The "regular menu" (44%) was most commonly served as 3 meals, no snacks at specific times. Energy and protein-dense menus were available, but not widespread (9%). Daily energy targets ranged from 1200 to 2400kcal and 32% of respondents viewed protein targets as important. The number of therapeutic diets varied from 2 to 150.Conclusions: Although hospital foodservice practices vary across Canada, the survey results demonstrate gaps in national evidence-based practices and an opportunity to formalize guiding principles. This work highlights the need for standards to improve practice through patient-centered, foodservice practices focused on addressing malnutrition.

Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation delivers improved hospital nutrition care processes and patient reported experiences - An implementation study.

Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures. Pre-implementation (n=365) and post-implementation (n=397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P< .01), nutrition information (30.9% vs 47.2%; P< .01), mealtime assistance where required (61.4% vs 77.9% P= .04), nutrition monitoring (25.2% vs 46.3%; P< .01) and care planning (17.8% vs 27.7%; P= .01). Patient-reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25; P= .83). Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources.

Exploring patient satisfaction with hospital foodservice: A Swedish study using the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire.

The aim of this study was to explore patient satisfaction with hospital foodservice in the Swedish setting, using a validated instrument, adding this context to the existing body of research. The study was carried out at three hospitals employing cyclic menus and conventional cook-serve foodservice systems with centralised tray assemblies and hot-trolley distributions to the wards for service. Patient satisfaction was explored using a translated version of the validated Acute Care Hospital Foodservice Patient Satisfaction Questionnaire. Groups were compared with Mann-Whitney U-test and Kruskal Wallis test with a set significance level of P < .05. Questionnaires from 439 patients were included in the analysis. The majority (80%) reported an overall satisfaction of "good" or "very good." Questions related to Staff and Service received mostly the highest possible ratings, while questions related to Food Quality and Meal Size had slightly lower ratings and higher variation. Comparisons between groups showed that differences were small even when statistically significant. Low appetite and a long hospital stay had an adverse effect on overall satisfaction and food quality-related questions. Men and younger patients reported more often being hungry after and between meals. Hospital foodservice faces the challenge of catering to multiple patient needs. Monitoring patient satisfaction is crucial to ensure that foodservice operations remain evidence based. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire provided a general overview that indicated foodservice areas with potential for improvement, although patient satisfaction overall was high. However, patient satisfaction is a complex measure and reflexivity is required when interpreting empirical results.

Entry-Level Registered Dietitian and Dietetic Technician, Registered Practice Today: Results From the 2020 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit

With responsibilities in the areas of credentialing, education, and practice standards, the Commission on Dietetic Registration (CDR), Accreditation Council for Education in Nutrition and Dietetics (ACEND), and the Academy of Nutrition and Dietetics have need of current, comprehensive information on dietetics practice. One response to this has been to periodically conduct empirical practice analyses to profile the activities with which dietitians and dietetic technicians are actually involved in their work. 1 Role Delineation and Verification for Entry-Level Positions in Community Dietetics. American Dietetic Association, Chicago, IL1983 Google Scholar , 2 Role Delineation and Verification for Entry-Level Positions in Foodservice Systems Management. American Dietetic Association, Chicago, IL1983 Google Scholar , 3 Role Delineation and Verification for Entry-Level Positions in Clinical Dietetics. American Dietetic Association, Chicago, IL1984 Google Scholar , 4 Kane M. Estes C. Colton D. Eltoft C. Role delineation for dietetic practitioners: empirical results. J Am Diet Assoc. 1990; 90: 1124-1133 Abstract Full Text PDF PubMed Google Scholar , 5 Kane M. Cohen A. Smith E. Lewis C. Reidy C. 1995 Commission on Dietetic Registration Dietetics Practice Audit. J Am Diet Assoc. 1996; 96: 1292-1301 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 6 Rogers D. Leonberg B. Broadhurst C. 2000 Commission on Dietetic Registration dietetics practice audit. J Am Diet Assoc. 2002; 102: 270-288 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 7 Rogers D. Fish J. 2005 Commission on Dietetic Registration entry-level dietetics practice audit. J Am Diet Assoc. 2006; 106: 957-964 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 8 Ward B. Rogers D. Mueller C. et al. 2010 Commission on Dietetic Registration entry-level dietetics practice audit. J Am Diet Assoc. 2011; 111: 914-941 Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar , 9 Griswold K. Rogers D. Sauer K. et al. Entry-level dietetics practice today: Results from the 2015 Commission on Dietetic Registration entry-level dietetics practice audit. J Acad Nutr Diet. 2016; 116: 1632-1684 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar D. Rogers is senior vice president at Readex Research, Stillwater, MN. K. Griswold is director of research team operations at Readex Research, Stillwater, MN. K. L. Sauer is chair, professor, Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan. E. Abbay is talent acquisition manager, Compass Group USA, Memphis, TN. A. Coufal is a dietitian assistant II, The University of Kansas Health System, Kansas City. W. Eastman is professor emerita, New Mexico State University, Las Cruces. K. Lawson is principal regulatory and scientific affairs specialist, Nestlé USA, Arlington, VA. D. Slack is director food and nutrition services, Reid Health, Richmond, IN. B. Sulik is director of education, Rocky Mountain Diabetes & Osteoporosis Center, Idaho Falls, ID.

Inclusion of Nutrition Expertise in Catering Operations at a Major Global Sporting Event: A Qualitative Case Study Using a Foodservice Systems Approach

BackgroundMajor sporting event catering is a significant undertaking for foodservice providers, particularly with an increasing focus on sustainability, global health, and nutrition demands of athletes. Yet, the inclusion of nutrition expertise in catering varies significantly between events. Foodservice systems models are commonly used to evaluate foodservice operations but to date have not been applied to catering and nutrition at major sporting events. ObjectiveThe aim of this exploratory case study was to gain in-depth insights of key stakeholders (catering management, chefs, organizers, and dietitians) regarding the integration of nutrition into the catering operation of a major global sporting event, with a focus on future continuity, and map this to the foodservice systems model using a program logic model. SettingSemistructured interviews were conducted with 12 stakeholders during and after the 2018 Commonwealth Games, Gold Coast, Australia. ResultsThe 8 themes that emerged were related to planning and preparation, refining processes, improvement of the menu, better technology, increase in food allergies/intolerances, organization controls, experience of the workforce, and increased client knowledge of nutrition. The logic model demonstrated that the system is driven by policy and budget at the level of control prior to and during the planning phase but modified by the environment during operation. ConclusionsDespite recognition by stakeholders on the importance of change, there are barriers to the provision of suitable food. Integration of nutrition expertise into tender documents and budgets in major event catering will help ensure nutritionally adequate, culturally suitable, and safe menus for future events.

“Saving” Plant Genetic Resources (&amp; Ourselves) in a Time of Accelerating Ecological Change

The articles in this issue examine the strategies that farmers, scientists, and citizens use to “save” the things that matter to us (our seeds, our bodies, our farms, and our communities) in the midst of accelerating, human-induced environmental degradation. They investigate the ways that these actors imagine the future—the ways that they seek to preserve what they see as vital, prevent what they see as unacceptable, and (sometimes) give in to what they see as unavoidable. The authors meticulously document the care that these actors invest in saving seeds, cultivating gardens, ensuring farm success, and documenting the information necessary for these things to be sustained (or resurrected) in an uncertain future. We begin by presenting a special issue of four articles that provide insight into the world of seed banking, which has become a major strategy for preserving plant genetic resources in the Anthropocene. The authors take us inside a few of the major institutions that play a role in collecting and preparing seeds for banking, exploring how they developed historically, how they function today, and who plays a role in caring for these seeds and determining their future use. Together, this collection helps us understand the political-economic machinations, the everyday labor, and the imagined futures involved in seed saving. Also in this issue, Janette Bulkan provides a meticulous overview of The Place of Bitter Cassava in the Social Organization and Belief Systems of Two Indigenous Peoples of Guyana. Drawing on historical resources and her own ethnographic research, Bulkan explains how and why cassava remains central to indigenous diets and cultural practices in Guyana, despite the availability of processed wheat flour and white rice. She pays particular attention to the role of women in cultivating cassava and protecting and disseminating knowledge about particular cultivars. She also explores the role of cassava in the areruya belief system. In Beyond Alternative Food Networks: Understanding Motivations to Participate in Orti Urbani in Palermo, Giuseppina Migliore, Pietro Romeo, Riccardo Testa, and Giorgio Schifani examine why residents of Palermo (the largest city in Sicily) choose to participate in urban gardening. While previous studies have focused on political motivations for involvement with orti urbani, the authors found citizens involved in these gardens were primarily concerned about eating safe food. Many cannot afford to buy organic foods; so they choose to grow their own. The authors frame their work within an interesting reading of the history of orti urbani and argue that Palermo should allocate more green space to these gardens. Thomas L. Henshaw considers collegiate food service systems in Is the Emergence of the “Fresh Prep” Food Service Provider an Entrée into Local Foods? Henshaw considers emergent strategies of food service firms, especially those who emphasize “fresh” products. Theoretically, the emphasis on fresh products should facilitate the purchase of locally produced, and therefore “fresher,” products. However, based on interviews with staff at eight liberal arts colleges in the Great Lakes region, he finds that the emphasis on freshness does little to change food service purchasing. Instead, food service managers should do more to increase institutional will and goals for local procurement, develop goals for purchasing, and enter into favorable contracts with growers. Finally, Andrea Rissing takes us to Iowa in “Profitability” vs. “Making It:” Causes and Consequences of Disembedding Beginning Farms’ Finances to consider what a successful farm really looks like. Based on ethnographic work with Iowans who have ended their farming enterprises, as well as bankers and farm consultants, Rissing shows how financial success does not necessarily lead to farming success. Instead, financial considerations intersect with family relationships, workload, and other lifestyle factors to constitute individuals’ ideals of farming “success.” She concludes that, despite the desire of farm financial advisors to consider monetary goals as central, farm financial health needs to be considered within a social context to more truthfully measure, and predict, success.

Foodservice quality in South African hospitals: patient experiences

PurposeThis paper presents an interpretive data analysis from a superordinate study that aimed to determine foodservice satisfaction. The purpose of this paper is to determine inpatient hospital foodservice experiences.Design/methodology/approachThe authors used secondary data obtained from 419 respondents: (225 (53.70 per cent) males, 178 (42.48 per cent) females and 16 (3.82 per cent) undisclosed) participants. A comparative, quantitative and cross-sectional approach was applied to provide insight into hospital foodservice experiences. The Wilcoxon–Mann–Whitney test, interpreted at 0.05 error rate, was used to compare male and female patient experiences.FindingsMale patients had significantly higher rank-sum scores than female patients in almost all items (p<0.0001). The study revealed that hospital personnel, especially foodservice staff, had an unsatisfactory communication approach.Originality/valueThis is the first South African study that compares female and male inpatient foodservice perceptions. Hospital managers and stakeholders may need to consider patient’s gender, as a significant factor that is associated with patient experiences, when embarking on improving foodservice systems.

How Widely are Supportive and Flexible Food Service Systems and Mealtime Interventions Used for People in Residential Care Facilities? A Comparison of Dementia-Specific and Nonspecific Facilities.

While improved mealtime practices can reduce agitation, improve quality of life, and increase food intake for people in aged care, the degree of implementation of these strategies is unknown. This study describes food service practices in residential aged care facilities, focusing on units caring for people with dementia. An online survey was distributed to residential aged care facilities for completion by the food service manager (n = 2057). Of the 204 responses to the survey, 63 (31%) contained a dementia-specific unit. Most facilities used adaptive equipment (90.2%) and commercial oral nutritional supplements (87.3%). A higher proportion of facilities with a dementia-specific service used high-contrast plates (39.7%) than those without (18.4%). The majority of facilities had residents make their choice for the meal more than 24 h prior to the meal (30.9%). Use of high contrast plates (n = 51, 25%) and molds to reform texture-modified meals (n = 41, 20.1%) were used by one-quarter or less of surveyed facilities. There is a relatively low use of environmental and social strategies to promote food intake and wellbeing in residents, with a focus instead on clinical interventions. Research should focus on strategies to support implementation of interventions to improve the mealtime experience for residents.

Determination of Cooking Degree of Boiled and Steam Cooked Potatoes (Solanum tuberosum L.) from a Physico-Chemical and Sensorial Perspective

Potatoes served in large-scale food service systems are often of poor quality. The current recommendation is to cook the potatoes until the core has reached a temperature of 96°C, but this recommendation is questionable. In this study, three potato varieties have been cooked by using conventional boiling (CB) to temperatures of 94°C and 96°C and steam cooking (SC) to temperatures of 92°C, 94°C and 96°C. The samples were thereafter analyzed by both texture and sensorial analyses. The results were evaluated with Partial Linear Squares Regression (PLSR). The perceived Softness and Cooking Degree from the sensorial analysis agreed with the hardness measured by the texture analyzer. The general impression of the samples showed that an undercooked tuber was preferable to an overcooked tuber, and that a cooking temperature of 96°C mostly resulted in overcooked tubers. The general impression depended on several parameters. Therefore, no optimal cooking temperature could be established.

"Meal realities" - An ethnographic exploration of hospital mealtime environment and practice.

To explore and understand patterns of mealtime culture, environment and social practice from the perspective of staff, volunteers and visitors on the hospital ward. Inadequate food intake is a common and complex problem in hospital and can lead to malnutrition. Mealtime interventions have been implemented to address this problem with limited success. A better understanding of mealtime environment and practice is needed to ascertain which interventions are more likely to be effective in addressing inadequate food intake in hospital. A qualitative, ethnographic approach was used to promote a comprehensive understanding of mealtime environment and practice. Sixty-seven hours of fieldwork was conducted August-October 2015. More than 150 participants were observed and 61 unique participants were interviewed in 75 interviews. Data analysis followed an inductive, thematic approach, informed by systems and complexity theory. Themes of "patient centredness" and "system" and their disharmonious interrelationship emerged. Staff, volunteers and visitors strive for patient centredness at mealtimes. The routine and structured nature of the meal and care systems was constantly in tension with providing patients the care they needed. The findings of this study expose the challenges associated with maintaining patient centredness at mealtimes in complex healthcare and foodservice systems. This facilitates a better understanding of why inadequate food intake is difficult to address in the hospital setting and highlights the need to support strategies that approach foodservice processes and nutritional care as complex and non-linear.

THE EFFECTS OF ROOM SERVICE TO IMPROVE PATIENTS’ FOOD SATISFACTION AND FOOD ACCEPTANCE

The improvement of patients’ food satisfaction and acceptance in the hospitals is primarily needed in the food service system. Room service is a new concept in the food service area. This study aims to compare the effects of two different types of food service systems; room service and conventional service system. The study with quasi-experimental design is conducted to the subject of 66 inpatients who were taken using a quota sampling method. Subjects were divided into different groups, the treatment groups (room service) and control groups (conventional). Leftover food between groups was compared for 9 large meals to determine acceptability. Food satisfaction is measured on the last day with using questionnaire. The study was conducted in April-June 2014. Chi-Square test and logistic regression were used for analysis of research data. There were significant differences food satisfaction (RR=4.6; p=0.0001) and food acceptance (RR=1.94; p=0.0488) between control and treatment group. The logistic regression test showed that room service group had higher food satisfaction and food acceptance level than control group after controlling confounding factors, which were 12,11 times (95% CI 3,593 – 37,219) and 2,38 times (95% CI 0,68-8,31), respectively. The room service increases food satisfaction and food acceptance of patients compared with conventional systems.