How to reduce processing times for site-specific assessments from 29 to 5 days using a common-sense approach: it does not have to be that hard.

Researchers have reported limitations with research governance processes across Australia. This study aimed to streamline research governance processes across a local health district. Four basic principles were applied to remove non-value-adding and non-risk-mitigating processes. Average processing times were reduced from 29 to 5 days and end-user satisfaction was improved, all within the same staffing levels.

How to streamline the low and negligible research ethics and governance review process from 80 to 10 days: submission to decision.

Most clinicians find research ethics and governance difficult and time consuming. This study aimed to develop a better local review process for low-risk research. We used real-time processing, leveraged local expertise and streamlined paperwork. As a result, turnaround times decreased from more than 80 days to 10 days, creating an efficient review process for low-risk projects.

Healthcare professionals' perspectives on the role of dietitians within multidisciplinary head and neck cancer teams: A qualitative multi-site study.

AIM: Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes. Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals. METHODS: This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines." CONCLUSIONS: While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study.

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

The experience of nutritional care according to patients with head and neck cancer involved with a combined dietitian, specialist nurse and speech pathologist clinic in a regional Australia: a qualitative longitudinal study.

PURPOSE: Malnutrition is a co-morbidity of head and neck cancer (HNC) that has negative consequences for patients. Evidence-based guidelines (EBGs) provide recommendations to prevent and manage malnutrition. A clinic that combines the services of a dietitian, specialist oncology nurse and speech pathologist may promote the implementation of nutritional EBGs in regional Australia. This study aimed to explore the nutritional care experience that patients with HNC had in this setting. METHODS: A qualitative longitudinal study collected data via semi-structured interviews with HNC patients who were treated in one regional cancer care network in Australia. Interviews were conducted at key points in their HNC journey from diagnosis to 4 months post-radiotherapy. Data was analysed using a grounded theory approach. RESULTS: Ten participants completed a total of thirty-six interviews. The findings were grouped into four categories: "preparing for nutritional challenges", "multidisciplinary care directed by patient needs", "the battle to eat", and "incongruence between patient values and nutritional priorities". CONCLUSION: These findings highlight the nutritional burden associated with HNC and barriers to patients accepting nutritional support from healthcare professionals. Information provided by doctors and nurses prior to treatment may help patients prepare for the nutritional challenges ahead and accept support from dietitians. Furthermore, clinics that promote continuity through treatment and allow dietitians to lead aspects of nutritional care, in collaboration with nurses, speech pathologists and doctors, may also enhance the nutritional care experience. More qualitative research within HNC teams would provide further insight on enhancing the implementation of nutritional EBGs to improve outcomes for these patients.

Improving knowledge translation for increased engagement and impact in healthcare.

Ineffective knowledge dissemination contributes to clinical practice and service improvements not being realised. Meaningful knowledge translation can occur through the understanding and matching of appropriate communication mediums that are relevant for different stakeholders or audiences. To this end, we present a dissemination instrument, the 'REAch and Diffusion of health iMprovement Evidence' (README) checklist, for the communication of research findings, integrating both traditional and newer communication mediums. Additionally, we propose a 'Strategic Translation and Engagement Planning' (STEP) tool, for use when deciding which mediums to select. The STEP tool challenges the need for communicating complex and simple information against the desire for passive or active stakeholder interaction. Used collaboratively by academics and health professionals, README and STEP can promote co-production of research, subsequent diffusion of knowledge, and develop the capacity and skills of all stakeholders.

Healthcare Professionals' Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments.

BACKGROUND: Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. METHODS: Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). CONCLUSION: Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.

The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review.

BACKGROUND AND AIMS: Patients undergoing treatment for head and neck cancer (HNC) can experience severe weight loss, malnutrition and dehydration which can cause treatment delays. Enteral feeding can reduce the risk of these. However, the use of feeding tubes (FT), including FT type and placement timing is debated. This paper aimed to describe the patient experience of having a FT during treatment for HNC. METHODS: A systematic literature review of qualitative studies was undertaken in the databases Web of Science, CINAHL, Scopus and Science Direct using Prospero and Joanna Brigg's Institute guidelines. RESULTS: Nine studies were included providing the perspectives of 159 patients who had a FT during treatment for HNC. 150 findings and 183 illustrations which were primarily patient quotes were extracted. Analysis resulted in 42 categories from which nine synthesized findings were produced. These are summarized as: initial reluctance and fear; different understandings and expectations; individual preferences around choice; physical discomfort; restrictions to social life and daily living; new challenges and responsibilities; gradual acceptance; a challenging but rewarding transition process; and overall a worthwhile decision. CONCLUSION: These findings highlight the nutrition-related burden patients with HNC experience and support the need for interdisciplinary healthcare teams that integrate dietetics and speech pathology. This review supports individualized approaches to FT placement decisions. Further well-designed studies are needed to better understand patient and cancer-service structural factors that may influence the experience of having a FT, to ensure that decisions are evidence-based and patient-centered for best outcomes.

Feasibility of home-based dietetic intervention to improve the nutritional status of older adults post-hospital discharge.

AIM: To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. METHODS: The Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment (MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status. RESULTS: Mean body weight improved significantly (P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) (P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index (BMI) < 23 kg/m2 ) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight (BMI 23-27 kg/m2 ) (1.4 ± 0.3 g/kg) or overweight (BMI>27 kg/m2 ) (1.1 ± 0.3 g/kg) peers (P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day). CONCLUSIONS: Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community.

The prevalence of diabetes after gestational diabetes - An Australian perspective.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are likely to develop diabetes in later life. International reports and reviews indicate a variable but generally high rate of conversion. However, data from international reports are difficult to apply to an Australian population. AIM: To investigate in Australia, in a representative population, the prevalence of diabetes developing in women who have been diagnosed with one criteria and who have had uniform standards of clinical care. MATERIAL AND METHODS: This study considered women referred with a diagnosis of GDM according to the Australasian Diabetes in Pregnancy Society criteria and seen by one practitioner over a 20 year period, from 1991 to 2010. The area of referral had an ethnic distribution similar to the overall Australian demography. RESULTS: Despite, in some cases, being more than 25 years since the pregnancy, more than half the women were contactable and the majority agreed to have their diabetes status declared or determined. The overall prevalence was 10.3%. The prevalence at each 10 year age increment was more than twice the figure reported from the AusDiab study. A higher maternal body mass index and a positive family history of diabetes were the strongest predictive factors. The prevalence of undiagnosed diabetes was 0.9%. CONCLUSION: In a representative population, after GDM, the prevalence of diabetes of 10.3% was far lower than that reported internationally but was still about twice the rate for the overall Australian population.

Consumer support for healthy food and drink vending machines in public places.

OBJECTIVE: To investigate the feasibility of introducing vending machines for healthier food into public places, and to examine the effectiveness of two front-of-pack labelling systems in the vending machine context. METHODS: A survey was conducted with 120 students from a university and 120 employees, patients and visitors of a hospital in regional NSW, Australia. Questions explored vending machine use, attitudes towards healthier snack products and price, and the performance of front-of-pack labelling formats for vending machine products. RESULTS: Most participants viewed the current range of snacks and drinks as "too unhealthy" (snacks 87.5%; drinks 56.7%). Nuts and muesli bars were the most liked healthier vending machine snack. Higher proportions of participants were able to identify the healthier snack in three of the five product comparisons when products were accompanied with any type of front-of-pack label (all p<0.01); however, participants were less likely to be able to identify the healthier product in the drinks comparison when a front-of-pack guide was present. CONCLUSION: Respondents were interested in a range of healthier snacks for vending machines. Front-of-pack label formats on vending machines may assist consumers to identify healthier products. IMPLICATIONS: Public settings, such as universities and hospitals, should support consumers to make healthy dietary choices by improving food environments.

Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study.

BACKGROUND: Nutrition screening in older adults is not routinely performed in Australian primary care settings. Low awareness of the extent of malnutrition in this patient group, lack of training and time constraints are major barriers that practice staff face. This study aimed to demonstrate the feasibility of including a validated nutrition screening tool and accompanying nutrition resource kit for use with older patients attending general practice. Secondary aims were to assess nutrition-related knowledge of staff and to identify the extent of malnutrition in this patient group. METHODS: Nine general practitioners, two general practice registrars and 11 practice nurses from three participating general practices in a rural, regional and metropolitan area within a local health district of New South Wales, Australia were recruited by convenience sampling. RESULTS: Four key themes were determined regarding the feasibility of performing MNA -SF: ease of use; incorporation into existing practice; benefit to patients' health; and patients' perception of MNA-SF. Two key themes related to the nutrition resource kit: applicability and improvement. These findings were supported by open ended questionnaire responses. Knowledge scores of staff significantly improved from baseline (52% to 66%; P < 0.05). Of the 143 patients that had been screened, 4.2% (n = 6) were classified as malnourished, 26.6% (n = 38) 'at risk' of malnutrition and 69.2% (n = 99) as well-nourished. CONCLUSION: It is feasible to include the MNA-SF and a nutrition resource kit within routine general practice, but further refinement of patients' electronic clinical records in general practice software would streamline this process.

Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes.

BACKGROUND: Eating carbohydrate foods with a high glycemic index (GI) has been postulated to result in fetoplacental overgrowth and higher infant body fat. A diet with a low glycemic index (LGI) has been shown to reduce birth percentiles and the ponderal index (PI). OBJECTIVES: We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight, birth percentile, and PI than providing healthy eating (HE) advice. This advice had to be presented within the resources of routine antenatal care. DESIGN: The Pregnancy and Glycemic Index Outcomes study was a 2-arm, parallel-design, randomized, controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes. Eligible volunteers who attended for routine antenatal care at <20 wk of gestation were randomly assigned to either group. RESULTS: A total of 691 women were enrolled, and 576 women had final data considered. In the LGI group, the GI was reduced from a mean (± SEM) of 56 ± 0.3 at enrollment to 52 ± 0.3 (P < 0.001) at the final assessment. There were no significant differences in primary outcomes of fetal birth weight, birth percentile, or PI. In a multivariate regression analysis, the glycemic load was the only significant dietary predictor (P = 0.046) of primary outcomes but explained <1% of all variation. CONCLUSION: A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight, fetal percentile, or PI.

'We are all time poor' -- is routine nutrition screening of older patients feasible?

BACKGROUND: Despite clinical guidelines that recommend routine nutrition screening of older patients, this does not generally occur in the Australian general practice setting. This study aimed to identify perceived barriers and opportunities to implementing nutrition screening of older people in general practice. METHODS: Twenty-five in-depth individual interviews were conducted with general practitioners, general practice registrars and practice nurses. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Observations were performed to identify opportunities to conduct nutrition screening within general practice workflow. RESULTS: The primary identified barrier to screening related to time constraints, which was further validated by the observational component of the study. The main opportunity for screening was seen to be within the existing Australian Government Medicare Benefits Schedule Primary Care Item, 'Health assessment for people aged 75 years and older'. DISCUSSION: Incorporation of a validated and short nutrition screening instrument into the existing Health assessment was identified as the most feasible way to encourage the uptake of nutrition screening in general practice.

Does a low glycaemic index (GI) diet cost more during pregnancy?

 The aim of this study was to examine the monetary cost of dietary change among pregnant women before and after receiving low glycaemic index (GI) dietary advice. The pregnant women in this study were a subgroup of participants in the Pregnancy and Glycaemic Index Outcomes (PREGGIO) study. Twenty women from the low GI dietary advice group, who had completed their pregnancies, were randomly chosen. All these women had completed three day food records at 12–16 weeks and again around 36 weeks of gestation. Consumer food prices were applied to recorded dietary intake data. The mean ± SD GI of the diet reduced from 55.1 ± 4.3 to 51.6 ± 3.9 (p = 0.003). The daily cost of the diet (AUD) was 9.1 ± 2.7 at enrolment and 9.5 ± 2.1 prior to delivery was not significantly different (p = 0.52). There were also no significant differences in the daily energy intake (p = 0.2) or the daily cost per MJ (p = 0.16). Women were able to follow low GI dietary advice during pregnancy with no significant increase in the daily costs.