Nutritional Care Of Patients Research Articles

Perceptions, Barriers and Facilitators Regarding Nutritional Care for Patients with Chronic Limb Threatening Ischemia: A Focus Group Study Among Healthcare Professionals

Nutrition and nutritional care are essential for optimal outcomes, and, therefore of importance for patients with chronic limb threatening ischemia (CLTI) given their high risk of complications. However, insight is lacking in how healthcare professionals directly involved in the care of patients with CLTI perceive nutritional care, as well as in the perceived barriers and facilitators regarding optimal nutritional care. In this qualitative study with a phenomenological approach, three online focus groups were conducted with various healthcare professionals directly involved in the care of patients with CLTI. Sample size was guided by information power. Focus group recordings were transcribed verbatim, and reflexive thematic analysis was performed. Seventeen healthcare professionals participated, including vascular surgeons, fellows in vascular surgery, a medical doctor and researcher, nurse specialized in wound care, general nurse, physical therapists, dietitians, and nutrition assistants. Four themes were generated: (1) nutritional care is crucial for optimal clinical outcomes and a healthy life, (2) insufficient attention to undernutrition and nutritional care by healthcare professionals, (3) patient-related factors challenge healthcare professionals in providing nutritional care, and (4) need for optimizing the organizational process related to nutritional care. Perceived barriers regarding nutritional care included knowledge deficits, nutritional care not being part of the healthcare professionals' routine, missing tools to identify undernutrition, patient-related factors, and time constraints. Facilitators regarding nutritional care included more scientific evidence regarding the effect of nutritional care on clinical outcomes and optimization of organizational processes related to nutritional care. Healthcare professionals perceive nutritional care as important for optimal outcomes, but nutritional care is not routinely implemented in the care of patients with CLTI. This lack of implementation of nutritional care may be due to the barriers perceived in various domains. The findings of this study stress the need to optimize nutritional care, with the aim of improving outcomes in the CLTI population.

S1411 Provider Perceptions and Practices Related to Nutrition Care in Patients with Inflammatory Bowel Disease

S1411 Provider Perceptions and Practices Related to Nutrition Care in Patients with Inflammatory Bowel Disease

Nutrition's Role in Quality Healthcare in the United States: Opportunities and Education for Pharmacists to Take a Bite of the Apple and Strengthen Their Skills.

With global chronic disease rates on the rise, diet and nutrition remain pivotal yet under-appreciated aspects of healthcare, including in pharmacy practice. This perspective paper delves into how current United States health policies support nutrition's role in healthcare and its integration into pharmacy practice. The paper also reviews the landscape of nutrition education and training for pharmacists, pharmacy roles in multidisciplinary teams and interprofessional nutrition care, and the opportunities for post-graduate nutrition-focused certification, training, and continuing education. It advocates for a paradigm shift towards greater emphasis on nutrition within pharmacy practice, to improve skills and benefit quality patient nutrition care.

#2002 Impact of personalized nutrition care in patients with advanced chronic kidney disease: ERCANUT RCT

Abstract Background and Aims A careful dietary plan is part of an integral treatment of patients with chronic kidney disease (CKD) stages 3 to 5 not on dialysis. It aims to slow disease progression, mitigate metabolic derangements and maintain adequate nutritional status. However, the dietary plan can overwhelm patients, affect their social life and increase anxiety and depression. Therefore, effective nutritional strategies are needed to improve the quality of the diet while also maintaining the quality of life (QoL). We analyzed the impact of personalized nutrition care (PNC) with a nutritional educational program on QoL, nutritional status, and anxiety and depression in patients with advanced CKD. Method ERCANUT is a 3-months RCT comprising 76 adult patients with GFR <30 ml/min/1.73 m2 who were randomized to study group (n = 38), which received PNC combined with a nutritional education program, or to the control group (n = 38) that received general dietary recommendations. Both groups received dietary counseling from the same dietitian to follow a healthy and protein-controlled diet (0.65-0.8 g/kg/day) based on Mediterranean pattern. The nutritional educational program in the study group consisted in three one-hour sessions, using nutritional coaching. Patients and relatives received information about healthy diet and lifestyle. They were encouraged to increase their physical activity. In addition, during the follow-up period (3 months), they had the support of health care professionals by phone calls and text messages. Baseline and 3-month data were collected: QoL (KDQOLTM-36), nutritional status (anthropometry and bioelectrical impedance) and grade of anxiety and depression (HADS). Dietary adherence was assessed using the short version of the Mediterranean diet adherence questionnaire. All patients were counselled by a dietitian to follow a diet containing whole grain foods, vegetables and fruits, nuts and extra virgin olive oil as the main dietary fat. Plant protein (legumes) was preferred over animal protein, especially processed meat and red meat. Patients were advised to reduce the intake of ultra-processed foods (UPFs). Only in case of the study group, they received a personalized diet according to their food preferences, energy and nutrients requirements and physical activity level. They were also supported by a cookbook created especially for the study. Results After three months, 67 patients (mean age 66.1 ± 14.9 years; 68% men; mean GFR 22.2 ± 3.1 mL/min/1.73 m2) finalized the study (control group n = 34, study group n = 33). No significant differences were observed between groups regarding age, sex, body mass index (BMI), serum albumin and Charlson index at baseline. QoL improved in 4 out of 5 domains in the study group (as can be seen in Table 1 as an increase in score), while in the control group there is a worsening in effects of disease and disease burden (score reduction at 3 months). In addition, anxiety and depression scores declined in the study group but not in the control group. In both groups, the adherence to the Mediterranean diet increased and BMI and markers of body fat decreased. Lean mass and phase angle decreased only in the control group. Conclusion This RCT shows that having the support of a dietitian improved dietary quality and markers of body fat, and the use of PNC with nutritional educational program improved aspects of QoL, reduced anxiety and depression, and maintained lean mass and phase angle. Therefore, the support from a dietitian and use of PNC in clinical practice seems to be effective in improving QoL, anxiety and depression.

Nutrition Management of the Adult Patient With Necrotizing Fasciitis

Necrotizing fasciitis is an invasive, life-threatening infection of the tissues. Necrotizing fasciitis is not a commonly seen infection, making it a challenging infection for many clinicians to treat and manage due to a lack of familiarity with the disease process. Further, there is limited research and guidance available regarding nutrition care for patients recovering from necrotizing fasciitis. This article presents a case study and highlights how currently available guidelines can be critically applied by dietitians to provide appropriate nutrition care in a relatively unfamiliar patient population.

Nutritional Care for Patients with Non St Elevation Myocardial Infarction (Nstemi)

Nutritional Care for Patients with Non St Elevation Myocardial Infarction (Nstemi)

Evidence Based Case Study: Efektivitas Pemberian Vitamin D Selama Masa Perawatan pada Pasien Stroke

The administration of vitamin D in stroke patients has been associated with functional improvement because it helps modify various cardiovascular risk factors. This study aimed to determine the effectiveness of vitamin D supplements to stroke patients. The design of this study used an evidence-based case study approach conducted in July 2023 by including an illustration case study along with several supporting research studies to strengthen the findings. The research studies were collected through PubMed, Proquest, and ScienceDirect based on the PICO framework. Seven studies were included to support the finding of the illustration case study related to the effectiveness of vitamin D administration. The results of the studies showed that there were variations in the effects of giving a single dose of vitamin D or with a combination of other nutritional elements including helping to reduce serum levels of interleukin-1β (IL-1β) and interleukin 6 (IL-6), improving the patient's neurological function, and preventing the secondary hyperparathyroidism. The positive effects of giving vitamin D were also showed during the rehabilitation period of stroke patients including improving mood regulation and functional recovery as well as improving lower extremity motor function and ambulation. The administration of vitamin D to stroke patients gives many positive contributions to both the acute and rehabilitation phases through various physiological mechanisms of the body. Health professionals are expected to consider adding vitamin D to a patient's nutritional care plan to achieve optimal health status outcomes.

Development of a protocol for nutritional care in patients undergoing CAR-T cell therapy

Development of a protocol for nutritional care in patients undergoing CAR-T cell therapy

Differing Experiences of Nutrition Care During Treatment Among Oncology Nurses, Providers, and Patients.

Provision of nutrition care for patients with cancer represents a key component of holistic oncology care. However, information is limited about the use and perceptions of registered dietitian-led nutrition care in the oncology setting. This study aimed to better understand the experiences and expectations of patients and healthcare workers regarding nutrition care during outpatient cancer treatment. Oncology care team members (N = 55) and patients (N = 90) completed a survey about their knowledge of and interest in nutrition care. A subset of participants completed semistructured interviews to capture experiences with and perspectives on nutrition care practices. The majority of patients (n = 73) reported experiencing at least one nutrition impact symptom, but only 14 indicated that they frequently discussed nutrition during provider visits. In addition, 40 oncology care team members indicated frequently discussing nutrition at visits, although 13 were unaware of local nutrition resources.

The impact of home enteral nutrition planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients

BackgroundStudies show that malnutrition is common among cancer patients, ranging from about 20% to more than 70%. It is known that malnutrition that is not managed properly worsens the course of the disease, prolongs the hospital stay, and impacts the quality of life and treatment toxicities. Malnutrition has many negative effects, therefore individualization and optimization of nutritional support is crucial for the patient's health. This study aimed to assess the impact of home enteral nutrition (HEN) planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients. MethodsThis prospective, observational study included 28 patients with cancer recruited at the Nutrition Clinic of Department of General, Gastroenterologic and Oncologic Surgery, of the Medical University of Warsaw from December 2021 to December 2022. All patients were supported with HEN setup based on individual caloric needs for 3 months. We evaluated nutritional status, body composition, and biochemical markers of malnutrition. ResultsFor 67.9 % of patients, using the equations rather than indirect calorimetry would underestimate energy needs. Individualized HEN resulted in weight loss stops in 46.4 % of patients. The average change in body mass in the study group was positive and was equal to 0.46 ± 6.73 kg. No significant differences were found when comparing the mid-arm circumference (MAC) and triceps skinfold thickness (SFT) before and after inclusion in HEN, although, as in the case of body mass SFT showed an upward trend. Moreover, the percentage of patients with insufficient total protein (TP) and serum albumin concentrations decreased. This difference was statistically significant for albumin. The Nutritional Risk Index (NRI) was also significantly higher. The analysis of body composition also showed a decrease in the percentage of patients with reduced fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA) value. ConclusionsThe results of our research highlight the significance of well-planned nutritional care for cancer patients. Utilizing HEN and individualized approaches can effectively preserve body mass, composition, and nutritional status while minimizing safety risks, ultimately improving quality of life. Indirect calorimetry if available can be helpful to optimize nutrition care for patients with cancer in HEN.

Associations between blood pressure control and clinical events suggestive of nutrition care documented in electronic health records of patients with hypertension

BackgroundClinical events suggestive of nutrition care found in electronic health records (EHRs) are rarely explored for their associations with hypertension outcomes.MethodsLongitudinal analysis using structured EHR data from primary care visits at a health system in the US from December 2017—December 2020 of adult patients with hypertension (n = 4,237) tested for associations between last visit blood pressure (BP) control (≤ 140 Systolic BP and ≤ 90 Diastolic BP) and ≥ 1 nutrition care clinical event operationalized as (overweight or obesity (BMI > 25 or 30, respectively) diagnoses, preventive care visits, or provision of patient education materials (PEM)). Descriptive statistics and longitudinal targeted maximum likelihood estimation (LTMLE) models were conducted to explore average treatment effects (ATE) of timing and dose response from these clinical events on blood pressure control overall and by race.ResultsThe median age was 62 years, 29% were male, 52% were Black, 25% were from rural areas and 50% had controlled BP at baseline. Annual documentation of overweight/obesity diagnoses ranged 3.0–7.8%, preventive care visits ranged 6.2–15.7%, and PEM with dietary and hypertension content were distributed to 8.5–28.8% patients. LTMLE models stratified by race showed differences in timing, dose, and type of nutrition care. Black patients who had nutrition care in Year 3 only compared to none had lower odds for BP control (ATE -0.23, 95% CI: -0.38,-0.08, p = 0.003), preventive visits in the last 2 years high higher odds for BP control (ATE 0.31, 95% CI: 0.07,0.54, p = 0.01), and early or late PEMs had lower odds for BP control (ATE -0.08, 95% CI: -0.15,-0.01, p = 0.03 and ATE -0.23, 95% CI: -0.41,-0.05, p = 0.01, respectively).ConclusionsIn this study, clinical events suggestive of nutrition care are significantly associated with BP control, but are infrequent and effects differ by type, timing, and patient race. Preventive visits appear to have the most effect; additional research should include examining clinical notes for evidence of nutrition care among different populations, which may uncover areas for improving nutrition care for patients with chronic disease.

Time to invest in nutritional care for patients with inflammatory bowel disease

Data suggest that the NHS lacks capacity to provide adequate nutritional care to patients with inflammatory bowel disease. Registered nutritionist and health visitor Sara Patience highlights the importance of nutritional care, alongside the human and financial costs of malnutrition in this patient group.

The European Society for Blood and Marrow Transplantation (EBMT) roadmap and perspectives to improve nutritional care in patients undergoing hematopoietic stem cell transplantation on behalf of the Cellular Therapy and Immunobiology Working Party (CTIWP) and the Nurses Group (NG) of the EBMT.

Malnutrition is the most common comorbidity during the continuum of hematopoietic stem cell transplant (HSCT) and negatively impacts clinical outcomes, response to therapy, quality of life, and costs. The intensive conditioning regimen administered before transplant causes inflammatory damages to the gastrointestinal system, which themselves contribute to trigger graft versus host disease (GvHD) in the allogeneic setting. GvHD and other post-transplant complications such as infections adversely affect food intake and gut absorption of nutrients. Consequently, patients exhibit signs of malnutrition such as weight loss and muscle wasting, thus triggering a "vicious circle" that favours additional complications. Among HSCT centres, there is marked variability in nutritional care, from screening for malnutrition to nutritional intervention. The present paper, elaborated by the Cellular Therapy and Immunobiology Working Party and the Nurses Group of the European Society for Blood and Marrow Transplantation, aims at defining a roadmap that identifies the main nutritional critical issues in the field of HSCT. This document will be propaedeutic to the development of clinical algorithms to counteract risk factors of malnutrition, based on scientific evidence and shared among HSCT centres, and thus maximize transplant outcomes.

Remote nutrition care during the first wave of COVID-19 pandemic: Did it impact nutrition therapy goals?

Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.

Co-design of a cancer nutrition care pathway by patients, carers, and health professionals: the CanEAT pathway

PurposeLimited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs.MethodsThis study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper.ResultsTwo co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance.ConclusionThe CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.

The current status for nutrition care in patients undergoing metabolic and bariatric to ensure safe practice.

The current status for nutrition care in patients undergoing metabolic and bariatric to ensure safe practice.

Multimodal cancer treatment and its association with nutrition care practices in patients with head and neck and esophageal cancer: an international prospective cohort study

Background: Both cancer and its’ treatment contribute to the development of malnutrition, particularly in cancers that impact nutrition intake such as head and neck (HNC) and esophageal (EC) cancers. This study was undertaken to explore the relationship between cancer treatment and nutrition care in patients with HNC and EC. Methods: Adult patients (≥18 years) with newly diagnosed head and neck (HN) or esophageal (ESO) cancers scheduled to receive cancer treatment were enrolled between 2016 and 2018 in the INFORM study, a longitudinal multi-centre prospective cohort study. Baseline clinical characteristics of patients, cancer characteristics, treatment type (chemotherapy/radiotherap y /surgery) and frequency, nutrition risk (Patient Generated Subjective Global Assessment Short Form (PG-SGA SF) and nutrition care were recorded. Results: 100 HNC and 51 EC patients were included. Data were collected across 4 time periods from baseline to 6 months at 11 sites in Canada, Australia Italy, The Netherlands and the United States. Seventy-nine percent of the patients were male with a mean (SD) age of 63 (10) years. At admission, the mean (SD) BMI was 27 (5) kg/m2 and 30% were current smokers. Baseline PGA-SGA SF was ≥ 4 indicating nutrition risk for 59% of the HNC and 77% of the EC patients. The number of cancer treatments was positively associated with increases in enteral (EN) and parenteral nutrition (PN). In HNC patients receiving a single cancer treatment, 39% required EN and with 3 cancer treatment types, 78% required EN. In EC requiring a single cancer treatment, 50% required EN and in patients with 3 cancer treatments 94% required EN. Conclusion: The number of cancer treatment modalities is associated with the intensity of nutrition therapy required to sustain the patients through their cancer journey.

Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours.

The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations.

Nutritional Care in Psychiatry: Assessing Health Professionals’ Knowledge, Attitude and Practices

Contemporary evidence suggests that proper nutrition plays a key role in the treatment and prevention of mental illness. This hospital-based descriptive cross-sectional study sought to examine health professionals’ knowledge, attitudes, and practices toward patient nutritional care. The study was conducted at the Bono Regional Hospital in Sunyani, Ghana. Eighteen (18) health professionals working at the hospital’s psychiatric unit were recruited for the study through the census. Semi-structured, self-administered questionnaires, prepared and administered via Google forms, were used to collect data for the study. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. There was a 100% response rate. Males constituted 66.7% of the sample. More than one-fourth (27.8%) of the respondents were community mental health officers, and the majority of them were full-time workers (66.7%). Most of the respondents worked 3-5 days per week (77.8%) and 6–8 hours per day (83.3%). The larger proportion of the sample had worked in the health sector for less than 2 years (72.2%). Based on our specified criteria, most of the respondents had adequate knowledge (83.3%), a positive attitude (94.4%), and good practices (83.3%) toward patient nutrition. Overall, knowledge, attitude, and practices toward patient nutritional care were good, suggesting that nutritional care has been recognized as an essential component of the treatment and prevention of mental illness at Bono Regional Hospital. It is however important that the management of the hospital ensures timely and adequate provision of essential logistics and resources needed for patient nutritional care.

Nhu cầu chăm sóc phục hồi chức năng cho người bệnh thoái hóa cột sống thắt lưng tại Bệnh viện Y học Cổ Truyền

Objectives: Describe the needs and level of met needs for rehabilitation for patients with lumbar degenerative disc disease (DDD). Methods: The study used a cross- sectional descriptive design, data were collected from 150 inpatients with DDD in three departments of internal medicine, surgery, and acupuncture of the hospital. The assessment of needs and meeting the needs of the patient's rehabilitation is based on five types of needs (including rehabilitation for pain relief, rehabilitation for mobility for patients, postural rehabilitation, mental care and nutritional care for patients. Assessment of rehabilitation needs for patients with lower back pain is based on the criteria for diagnosis and treatment of patients with DDD according to the "Guidelines for diagnosis and treatment of osteo-muscular diseases” by the Ministry of Health, the questionnaire includes a set of questions on five rehabilitation needs. The data were analyzed descriptively using software SPSS 20.0. Results: There were 89,47% of patients with all five groups of rehabilitation needs, the need for rehabilitation and pain relief accounted for 98%; meeting the needs for mobilization reached 79.33%; the need for postural rehabilitation accounted for 97,33%; mental care needs account for 80,00%, nutritional care need was 92,67%. Conclusion: The current needs of rehabilitations is high among patients in the traditional medicine hospital, accounting for 89,47%. Hospitals need to strengthen their response to nutritional care needs, postural rehabilitation needs, by improving the professional qualifications of medical staff, considering related policies so that patients can receive faster treatment. Keywords: Needs, care, rehabilitation, lumbar spine degeneration, Vietnam