Meeting the challenge of providing nutrition services during the COVID-19 pandemic

We, registered dietitian nutritionists (RDNs), could have sat on the sidelines in the early days of the pandemic when many RDNs were not considered "essential" workers. Instead, RDNs used their abilities to innovate and adapt to ensure the public, their patients, and clients received continuous nutrition services. Some of the strategies adopted were possible because of temporary or emergency flexibilities in policies. We present examples primarily from our outpatient practices, with efforts by public health and inpatient RDNs acknowledged. We hope these examples will inspire all to do the work needed to provide increased access to medical nutrition therapy and nutrition education for all.

PNS192 Defining the New Age of Digital Health? Results of a Systematic Scoping Literature Review

Objectives: COVID-19 has accelerated the use of digital health, however, there is no universally accepted definition. The objective of this scoping review was to provide an overview of definitions in the literature including the context in which it exists e.g. public health organization, supplier organization, etc. to derive those which are aligned with the ISPOR mission of outcomes research. Methods: A literature search was undertaken for the past 5 years (2015-2020) on the major specific terms used in digital health (n=38) where these exist with synonyms of definition as a key term. Databases searched included Embase, PubMed/Medline, Cochrane Library and EconLit. A team of 2 volunteers independently reviewed each abstract to identify those which were likely to contain a definition or taxonomy and then reconciled any misalignment between the authors or referred the abstract to a third-party reviewer. Independent review by 2 volunteers was also employed to extract the relevant parameters in a recording spreadsheet from the full paper review. Results: From 2966 hits in the four different databases (Embase: n=2263;PubMed: n=657, Cochrane n=35, EconLit: n=11), the scoping review identified 2,610 original abstracts. Fifteen teams of two independent volunteers undertook the review of the abstracts. The agreement between the initial assessments of rater pairs was between 97.1% and 36.2%. Cohen’s kappa ranged from 0.91 to 0.11. A third reviewer reconciled disagreement in 73 (2.8%) citations. The number of abstracts taken through to the full paper review was 545 (20.9%). Conclusions: This timely work indicates that definitions included in the literature cover several terms which can be grouped under different applications of digital health. An overview of the different terms and their context to identify options which align with the ISPOR Mission will be presented.

Feeding a Person with Advanced Alzheimer's Disease: An Update

We update our 2011 discussion of feeding the person with late-stage or advanced Alzheimer's disease (advanced AD). We present a case of a 92-year-old woman diagnosed with AD, from our family medicine practice who was brought to the emergency department with fever and a change in mental status. Previously, neither she nor her family had received counseling about the typical trajectory of AD, nor had she made end-of-life plans. We present a discussion of the typical trajectory of AD, involuntary weight loss, advance care planning related to nutrition, and hydration and alternatives to tube feeding. We added a note describing the initial impact of COVID-19 on care. © 2020 Wolters Kluwer Health, Inc. All rights reserved.