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1.
J Hum Nutr Diet ; 2020 Jan 07.
Article in English | MEDLINE | ID: mdl-31912581

ABSTRACT

BACKGROUND: To explore the barriers and enablers experienced by nutrition and dietetic professionals in the implementation of the standardised Nutrition Care Process (NCP) across 10 different countries. NCP related beliefs, motivations and values were investigated and compared. METHODS: A validated online survey was disseminated to nutrition and dietetics professionals in 10 countries in the local language during 2017. Cross-sectional associations and differences between countries were explored for level of implementation, barriers/enablers and attitudes/motivation among the respondents. RESULTS: Higher NCP implementation was associated with greater occurrence of enabling aspects, as well as fewer occurrences of barriers. The most common enabler was 'recommendation by the national dietetic association' (69%) and the most common barrier was 'lack of time' (39%). A longer experience of NCP use was associated with a more positive attitude towards all NCP aspects. Differences between countries were identified, regarding both the occurrence of barriers/enablers and attitudes/motivations. CONCLUSIONS: Implementation efforts need to be tailored to country-specific contexts when implementing a new standard of care framework among nutrition and dietetic professionals. Additional research is needed to further assess the management and workplace strategies to support the development of nutrition and dietetics professionals in multidisciplinary healthcare organisations.

2.
BMC Geriatr ; 16: 24, 2016 Jan 21.
Article in English | MEDLINE | ID: mdl-26797091

ABSTRACT

BACKGROUND: Nursing home (NH) patients have complex health problems, disabilities and needs for Advance Care Planning (ACP). The implementation of ACP in NHs is a neglected research topic, yet it may optimize the intervention efficacy, or provide explanations for low efficacy. This scoping review investigates methods, design and outcomes and the implementation of ACP (i.e., themes and guiding questions, setting, facilitators, implementers, and promoters/barriers). METHODS: A systematic search using ACP MESH terms and keywords was conducted in CINAHL, Medline, PsychINFO, Embase and Cochrane libraries. We excluded studies on home-dwelling and hospital patients, including only specific diagnoses and/or chart-based interventions without conversations. RESULTS: Sixteen papers were included. There were large variations in definitions and content of ACP, study design, implementation strategies and outcomes. Often, the ACP intervention or implementation processes were not described in detail. Few studies included patients lacking decision-making capacity, despite the fact that this group is significantly present in most NHs. The chief ACP implementation strategy was education of staff. Among others, ACP improved documentation of and adherence to preferences. Important implementation barriers were non-attending NH physicians, legal challenges and reluctance to participate among personnel and relatives. CONCLUSION: ACP intervention studies in NHs are few and heterogeneous. Variation in ACP definitions may be related to cultural and legal differences. This variation, along with sparse information about procedures, makes it difficult to collate and compare research results. Essential implementation considerations relate to the involvement and education of nurses, physicians and leaders.


Subject(s)
Advance Care Planning/organization & administration , Aging/psychology , Homes for the Aged/statistics & numerical data , Mental Competency , Nursing Homes/statistics & numerical data , Terminal Care , Communication Barriers , Decision Making/ethics , Humans , Terminal Care/methods , Terminal Care/psychology
3.
Epidemiol Infect ; 143(3): 486-93, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24813906

ABSTRACT

We investigated an outbreak of gastroenteritis following a Christmas buffet served on 4-9 December 2012 to ~1300 hotel guests. More than 300 people were reported ill in initial interviews with hotel guests. To identify possible sources of infection we conducted a cohort investigation through which we identified 214 probable cases. Illness was associated with consumption of scrambled eggs (odds ratio 9·07, 95% confidence interval 5·20-15·84). Imported chives added fresh to the scrambled eggs were the suspected source of the outbreak but were unavailable for testing. Enterotoxigenic Escherichia coli (ETEC) infection was eventually confirmed in 40 hotel guests. This outbreak reinforces that ETEC should be considered in non-endemic countries when the clinical picture is consistent and common gastrointestinal pathogens are not found. Following this outbreak, the Norwegian Food Safety Authority recommended that imported fresh herbs should be heat-treated before use in commercial kitchens.


Subject(s)
Disease Outbreaks , Enterotoxigenic Escherichia coli/isolation & purification , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Gastroenteritis/epidemiology , Gastroenteritis/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Food Microbiology , Humans , Male , Middle Aged , Norway/epidemiology , Retrospective Studies , Young Adult
4.
Eur J Cancer Care (Engl) ; 21(4): 505-16, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22309292

ABSTRACT

Health-related quality of life (QoL) is a goal in nutritional oncology but the association between nutritional status and QoL is rarely explored. The aim of the study was to investigate the association of nutritional assessment criteria with QoL in 50 patients with advanced colorectal carcinoma. A second aim was to investigate changes in body weight and QoL during a 3-month follow-up. Muscle mass, nutritional risk, malnutrition and cachexia according to three different criteria were assessed, as well as health-related QoL. At inclusion, 36 patients experienced weight loss, 10 patients sarcopenia, 25 were at nutritional risk, 16 were malnourished and 11, 14 and 31 patients had cachexia according to different criteria. All nutritional assessment criteria discriminated between groups of patients with worse or better QoL to varying degrees. Malnutrition and cachexia defined by the European Palliative Care Research Collaborative and adjusted for recent gain or stabilisation of body weight discriminated on most QoL scores. Weight loss at follow-up was associated with a decrease in several QoL scores. Recognition of weight loss as well as diagnosing malnutrition and cachexia should be the first steps in an interventional pathway to enhance nutritional status and QoL in patients with advanced colorectal carcinoma.


Subject(s)
Carcinoma/psychology , Colorectal Neoplasms/psychology , Health Status , Nutrition Assessment , Quality of Life , Adult , Aged , Aged, 80 and over , Body Weight , Cachexia/psychology , Cohort Studies , Female , Humans , Male , Malnutrition/psychology , Middle Aged , Nutritional Status
5.
J Hum Nutr Diet ; 21(3): 239-47, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18477179

ABSTRACT

BACKGROUND: According to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians' expertise in the hospital units and, further, to assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition. METHODS: A questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common, as well as to 678 clinical dietitians working in Scandinavian hospitals. RESULTS: The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians. CONCLUSIONS: The present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus on clinical nutrition.


Subject(s)
Dietetics/standards , Malnutrition/therapy , Nursing Staff, Hospital/psychology , Nutritional Support/standards , Patient Care Team , Physicians/psychology , Adult , Female , Humans , Male , Nutrition Assessment , Surveys and Questionnaires
6.
Nucleic Acids Res ; 27(5): 1271-4, 1999 Mar 01.
Article in English | MEDLINE | ID: mdl-9973613

ABSTRACT

An allylic adenosine triphosphate analog (AATP) was tested as a substrate for commercially available DNA polymerases. All but one of the enzymes assayed incorporated AATP opposite thymidine (T) with concomitant termination of the elongation reaction. A concentration of only 1 microM was sufficient for complete termination of the polymerization reaction for a short template mediated by Ampli Taq DNA polymerase FS (Taq FS). This result suggests that AATP could be used as a 2',3'-dideoxyadenosine-5'-triphosphate (ddA) surrogate. Kinetics of incorporation revealed that AATP was 48 times less efficiently incorporated than ddA. Furthermore, AATP was used in dye-primer sequencing as a substitute for ddA.


Subject(s)
Adenosine Triphosphate/analogs & derivatives , DNA Replication/drug effects , DNA-Directed DNA Polymerase/metabolism , Adenosine Triphosphate/chemical synthesis , Adenosine Triphosphate/metabolism , Adenosine Triphosphate/pharmacology , Base Sequence , Boron Compounds , DNA/metabolism , DNA Primers , Fluorescent Dyes , Kinetics , Substrate Specificity , Templates, Genetic
9.
JPEN J Parenter Enteral Nutr ; 12(5): 521-5, 1988.
Article in English | MEDLINE | ID: mdl-3184425

ABSTRACT

N-3 fatty acid deficiency is described in a 7-year-old girl who had been fed solely by gastric tube from the age of 3 years. She had received the same nutrient during the last 22 months, supplying 16.2% of calories from linoleate and 0.07% from alpha-linolenate. She weighed 9.5 kg at the age of 3, and 10.3 kg at the start of the study, the weight being constant the last 15 months. She was now supplemented daily with 1.2 ml of a linseed- and cod liver-oil mixture (5:1, v/v), thereby increasing her alpha-linolenate intake to 0.71% and total N-3 fatty acids to 0.74% of total energy. Two months later, her rate of weight gain was 0.43 kg/month. After 5 months, the fatty acid supplement was changed to 7.5 ml of cod liver oil daily, thereby changing alpha-linolenate and total N-3 acid intake to 0.10% and 1.3% of total energy, respectively. Her rate of weight gain now increased to 0.64 kg/month, and her length increased from 117 to 122 cm in 5 months. The results indicate that the optimal dietary requirement for N-3 fatty acids in this child is higher than 0.74%, and extrapolation estimated the optimal requirement to be 1.1%-1.2% of total calories. The results suggest that N-3 fatty acids are required for normal growth in man.


Subject(s)
Cod Liver Oil/pharmacology , Fatty Acids, Unsaturated/deficiency , Fish Oils/pharmacology , Growth/drug effects , Linseed Oil/pharmacology , Child , Fatty Acids, Unsaturated/analysis , Female , Food, Formulated/analysis , Humans
11.
Article in English | MEDLINE | ID: mdl-2890285

ABSTRACT

Alpha-linolenic acid deficiency (ALAD) is described in five adults receiving long-term gastric tube feeding with a commercially available powdered formula mixed with water and/or skimmed milk. Three patients receiving the same powder mixed with whole milk showed no signs of essential fatty acid deficiency (EFAD). The patients showed scaly dermatitis and skin atrophy. In four patients, supplementing with cod liver oil and soya oil for 4 weeks normalized n-3 acids in plasma and red cells, while n-6 acids remained unchanged or decreased slightly. At the same time, skin changes were normalized. In the fifth patient, supplementing with ethyl linolenate started to normalize skin changes within 5 days, and after 2 weeks had increased the red cell concentration of 22:6n-3 threefold. Simultaneously, 20:4n-6 increased twofold, to above control level. Minimal daily requirement of alpha-linolenic acid and of long-chain n-3 acids is estimated to be 0.2% to 0.4% and 0.1% to 0.2% of calories, respectively.


Subject(s)
Dietary Fats, Unsaturated/therapeutic use , Fatty Acids, Essential/therapeutic use , Linolenic Acids/deficiency , Adult , Fatty Acids/blood , Humans , Nutritional Requirements , alpha-Linolenic Acid
12.
Am J Clin Nutr ; 45(1): 66-77, 1987 Jan.
Article in English | MEDLINE | ID: mdl-2879436

ABSTRACT

Alpha-linolenic acid deficiency is described in four adults fed by gastric tube. In plasma and erythrocytes, total lipid 20:3n-9 was slightly increased but total n-6 fatty acids, arachidonic acid, and dihomo-gamma-linolenic acid were normal. Total n-3 fatty acids, 18:3n-3, 20:5n-3, 22:5n-3, and 22:6n-3 were decreased in both plasma and erythrocytes. Patients had a slight but definite scaly dermatitis, which disappeared with essential fatty acids supplementation. Simultaneously, levels of 18:3n-3, 20:5n-3, 22:5n-3, 22:6n-3, 20:3n-9, and total n-3 fatty acids became normal while 18:2n-6, 20:3n-6, 20:4n-6, and total n-6 acids were unchanged or slightly lowered. Estimated minimal daily requirement of linolenic acid and of long-chain unsaturated n-3 acids in adults is approximately 0.2-0.3% and 0.1-0.2%, respectively, of total energy intake. Results suggest that conversion of linolenic acid to 22:6n-3 is increased in linolenic acid deficiency.


Subject(s)
Fatty Acids, Unsaturated/administration & dosage , Linolenic Acids/deficiency , Parenteral Nutrition/adverse effects , Aged , Aged, 80 and over , Erythrocytes/metabolism , Fatty Acids, Unsaturated/blood , Female , Humans , Linolenic Acids/administration & dosage , Linolenic Acids/blood , Lipids/blood , Middle Aged , Nutritional Requirements , Time Factors , alpha-Linolenic Acid
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